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This study aims at evaluating the role of DTI-ALPS in the diagnostic and therapeutic management of normal pressure hydrocephalus (NPH).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Twenty-one NPH patients underwent 3 Tesla MRI DTI-ALPS before and after lumbar tap test (TT). Depending on the response to TT, patients were divided into a responsive cohort (15 responders, R) and non-responsive cohort (6 non-responders, NR). R patients underwent ventriculoperitoneal shunt (VPS) surgery, with clinical assessment upon discharge and at a 3-month follow-up (FU) visit; nine patients repeated DTI-ALPS MRI at FU. Besides, 8 matched healthy controls (HC) underwent the same MRI protocol.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>The pre-TT ALPS-index in NPH patients (R: 1.003\u2009\u00b1\u20090.108, NR: 0.960\u2009\u00b1\u20090.079) was significantly lower compared to the HC (1.263\u2009\u00b1\u20090.161, p\u2009&lt;\u20090.01). The pre-TT ALPS-index in R patients was higher than in NR patients, though not significantly (p\u2009=\u20090.39). Compared to the pre-TT values, the ALPS-index of the R group increased both post TT (1.069\u2009\u00b1\u20090.122, p\u2009=\u20090.0499) and post VPS (1.120\u2009\u00b1\u20090.117, p\u2009=\u20090.041), in accordance to the clinical outcome.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>DTI-ALPS, reflecting the GS function, resulted significantly lower in NPH patients than in healthy controls. Secondly, clinical improvement was associated with DTI-ALPS increase both after a positive response to TT and at long term follow-up following VPS surgery. Therefore, DTI-ALPS index could be a promising, rapid and non-invasive radiological biomarker for the pre-surgical evaluation and prognosis of NPH patients.\n<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s10072-025-08308-2","type":"journal-article","created":{"date-parts":[[2025,6,16]],"date-time":"2025-06-16T17:25:15Z","timestamp":1750094715000},"page":"4433-4443","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Implications of the glymphatic system in the diagnostic and surgical workup of normal pressure hydrocephalus"],"prefix":"10.1007","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8818-1317","authenticated-orcid":false,"given":"Morgan","family":"Broggi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edoardo M.","family":"Barbieri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Gans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascuzzo","family":"Riccardo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica","family":"Redaelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"Aquino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Restelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Schiariti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Acerbi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Di Fede","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Ferroli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Grisoli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Doniselli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,6,16]]},"reference":[{"issue":"3","key":"8308_CR1","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1016\/J.MOLMED.2019.11.008","volume":"26","author":"BC Reeves","year":"2020","unstructured":"Reeves BC et al (2020) Glymphatic system impairment in Alzheimer\u2019s disease and idiopathic normal pressure Hydrocephalus. 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