Objective: To investigate whether Parkinson’s disease (PD) exhibits imaging features similar to normal pressure hydrocephalus (NPH) by comparison with healthy controls and NPH patients, and to identify factors associated with NPH-like imaging changes in PD.

Background: Recent studies suggest that NPH frequently coexists with PD, although the causal relationship remains unclear. Alterations in cerebrospinal fluid (CSF) spaces are considered a sensitive imaging marker of NPH. The disproportionately enlarged subarachnoid-space hydrocephalus (DESH) index, derived from ventricular, Sylvian fissure/basal cistern, and high-convexity CSF space volumes, has been proposed as a quantitative marker of hydrocephalus. We quantitatively evaluated CSF space alterations using the DESH index in healthy controls, PD, and NPH.

Method: We analyzed 391 healthy controls, 81 patients with NPH, and 75 patients with PD aged 50–89 years diagnosed according to established criteria. Ventricular and subarachnoid CSF spaces were automatically segmented from 3D T1-weighted MRI using SYNAPSE Vincent CSF Space Analysis (Fujifilm). DESH, Venthi, and Sylhi indices were calculated. Group comparisons were performed using the Steel–Dwass test. Outliers were excluded using the 1.5×IQR rule. Associations with age, sex, and disease duration were assessed using Spearman’s correlation. ANCOVA was performed using healthy controls as the reference with age and sex as covariates.

Results: The DESH index was significantly higher in NPH than in controls, whereas PD showed no significant difference. Venthi index was higher in both NPH and PD compared with controls. Sylhi index was increased in NPH but decreased in PD. Basal cistern volume increased in both diseases, whereas high-convexity volume decreased in NPH but increased in PD. Aging was associated with ventricular enlargement and reduced high-convexity volume (P < 0.05). Similar trends were observed in disease groups but were unrelated to disease duration.

Conclusion: In PD, ventricular enlargement was observed similar to NPH, but other cerebrospinal fluid compartments showed the opposite pattern. These findings indicate that PD has changes in cerebrospinal fluid spaces that are different from those in NPH and normal subjects.

References: Sakurai, A., Tsunemi, T., Shimada, T., Kawamura, K., Nakajima, M., Miyajima, M., & Hattori, N. (2022). Effect of comorbid Parkinson’s disease and Parkinson’s disease dementia on the course of idiopathic normal pressure hydrocephalus. Journal of Neurosurgery, 137(5), 1302-1309. https://doi.org/10.3171/2022.1.JNS212282

Craven CL, Toma AK, Mostafa T, Patel N, Watkins LD. The predictive value of DESH for shunt responsiveness in idiopathic normal pressure hydrocephalus. J Clin Neurosci. 2016 Dec;34:294-298. doi: 10.1016/j.jocn.2016.09.004. Epub 2016 Sep 28.

Shigeki Yamada, Hirotaka Ito, Chifumi Iseki, Toshiyuki Kondo, Tomoyasu Yamanaka, Motoki Tanikawa, Tomohiro Otani, Satoshi Ii, Yasuyuki Ohta, Yoshiyuki Watanabe, Shigeo Wada, Marie Oshima, Mitsuhito Mase, Deep learning assessment of disproportionately enlarged subarachnoid-space hydrocephalus in Hakim’s disease or idiopathic normal pressure hydrocephalus, Radiology Advances, Volume 1, Issue 3, September 2024,

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MDS Abstracts - https://www.mdsabstracts.org/abstract/quantitative-analysis-of-the-desh-in-normal-pressure-hydrocephalus-and-parkinsons-disease/