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We investigated cortical CBF utilizing surface\u2010based early\u2010phase <jats:sup>18<\/jats:sup>F\u2010florbetaben (E\u2010FBB) PET analysis in two groups: INPH patients and healthy controls. All 39 INPH patients and 20 healthy controls were imaged with MRI, including three\u2010dimensional volumetric images, for automated surface\u2010based cortical thickness analysis across the entire brain. A subgroup with 37 participants (22 INPH patients and 15 healthy controls) that also underwent <jats:sup>18<\/jats:sup>F\u2010fluorodeoxyglucose (FDG) PET imaging was further analyzed. Compared with age\u2010 and gender\u2010matched healthy controls, INPH patients showed statistically significant hyperperfusion in the high convexity of the frontal and parietal cortical regions. Importantly, within the INPH group, increased perfusion correlated with cortical thickening in these regions. Additionally, significant hypoperfusion mainly in the ventrolateral frontal cortex, supramarginal gyrus, and temporal cortical regions was observed in the INPH group relative to the control group. However, this hypoperfusion was not associated with cortical thinning. A subgroup analysis of participants that also underwent FDG PET imaging showed that increased (or decreased) cerebral perfusion was associated with increased (or decreased) glucose metabolism in INPH. A distinctive regional relationship between cerebral cortical perfusion and cortical thickness was shown in INPH patients. Our findings suggest distinct pathophysiologic mechanisms of hyperperfusion and hypoperfusion in INPH patients.<\/jats:p>","DOI":"10.1002\/hbm.25974","type":"journal-article","created":{"date-parts":[[2022,9,14]],"date-time":"2022-09-14T14:00:10Z","timestamp":1663164010000},"page":"269-279","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Distinct cerebral cortical perfusion patterns in idiopathic normal\u2010pressure hydrocephalus"],"prefix":"10.1002","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7248-2681","authenticated-orcid":false,"given":"Kyunghun","family":"Kang","sequence":"first","affiliation":[{"name":"Department of Neurology, School of Medicine Kyungpook National University  Daegu South Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5680-8314","authenticated-orcid":false,"given":"Shin 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