{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T17:39:52Z","timestamp":1793468392456,"version":"4.5.0"},"reference-count":37,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Swedish Foundation for Strategic Research"},{"name":"Umea University"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Fluids Barriers CNS"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background and purpose<\/jats:title>\n            <jats:p>Disproportionately enlarged subarachnoid space hydrocephalus (DESH) is a radiological biomarker for idiopathic normal pressure hydrocephalus (iNPH). DESH is a subjective measure, based on visual assessments, which may limit its reliability. The aim of this study was to develop and validate a method for the objective quantification of DESH.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Materials and methods<\/jats:title>\n            <jats:p>By using a semiautomatic quantitative method, we calculated quantitative DESH (qDESH), defined as a ratio between CSF volumes at high convexities and Sylvian fissures. The analysis was based on three-dimensional T1-weighted images\u00a0from 35 subjects with iNPH (mean age 74 yrs; 10 females) and 45 controls (mean age 72 yrs; 13 females). The interrater agreement for qDESH was evaluated by the intraclass correlation coefficient, and qDESH was compared with visual assessments performed by two neuroradiologists.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>All subjects with iNPH and 13% of the controls visually scored DESH positive. The median qDESH was 2.48 (5th to 95th percentile 0.88 to 5.42) for iNPH and 0.63 (5th to 95th percentile 0.37 to 1.73) for the controls. The area under the receiver operating characteristic curve for qDESH was 0.95 (95% confidence interval 0.90\u20131) in separating iNPH patients from controls. The interrater agreement for qDESH was 0.99 (95% CI 0.986\u20130.994, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Unlike visual DESH, qDESH generates a continuous variable, enabling reproducible quantification of DESH severity. With this method we can objectively investigate the diagnostic accuracy and prognostic assessment of DESH in iNPH.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12987-025-00677-2","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T13:51:50Z","timestamp":1751377910000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["qDESH: a method to quantify disproportionately enlarged subarachnoid space hydrocephalus"],"prefix":"10.1186","volume":"22","author":[{"given":"Sofia","family":"Behndig","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afroditi","family":"Lalou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Axelsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenny","family":"Larsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"W\u00e5hlin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pavel","family":"Ryska","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ondrej","family":"Slezak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katrine","family":"Riklund","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Zizka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Malm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Eklund","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,7,1]]},"reference":[{"key":"677_CR1","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1056\/NEJM196507152730301","volume":"273","author":"RD Adams","year":"1965","unstructured":"Adams RD, Fisher CM, Hakim S, Ojemann RG, Sweet WH. Symptomatic occult hydrocephalus with normal cerebrospinal-fluid pressure: a treatable syndrome. N Engl J Med. 1965;273:117\u201326.","journal-title":"N Engl J Med"},{"key":"677_CR2","first-page":"1277","volume":"19","author":"H Kitagaki","year":"1998","unstructured":"Kitagaki H, Mori E, Ishii K, Yamaji S, Hirono N, Imamura T. CSF spaces in idiopathic normal pressure hydrocephalus: morphology and volumetry. Am J Neuroradiol. 1998;19:1277\u201384.","journal-title":"Am J Neuroradiol"},{"key":"677_CR3","doi-asserted-by":"publisher","first-page":"63","DOI":"10.2176\/nmc.st.2020-0292","volume":"61","author":"M Nakajima","year":"2021","unstructured":"Nakajima M, Yamada S, Miyajima M, Ishii K, Kuriyama N, Kazui H, et al. Guidelines for management of idiopathic normal pressure hydrocephalus (Third edition): endorsed by the Japanese society of normal pressure hydrocephalus. Neurol Med Chir. 2021;61:63\u201397.","journal-title":"Neurol Med Chir"},{"key":"677_CR4","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1111\/ene.13555","volume":"25","author":"K Kockum","year":"2018","unstructured":"Kockum K, Lilja-Lund O, Larsson EM, Rosell M, S\u00f6derstr\u00f6m L, Virhammar J, et al. The idiopathic normal-pressure hydrocephalus Radscale: a radiological scale for structured evaluation. Eur J Neurol. 2018;25:569\u201376.","journal-title":"Eur J Neurol"},{"key":"677_CR5","doi-asserted-by":"publisher","first-page":"74","DOI":"10.3174\/ajnr.A5910","volume":"40","author":"S Agerskov","year":"2019","unstructured":"Agerskov S, Wallin M, Hellstr\u00f6m P, Ziegelitz D, Wikkels\u00f6 C, Tullberg M, et al. Absence of disproportionately enlarged subarachnoid space hydrocephalus, a sharp callosal angle, or other morphologic MRI markers should not be used to exclude patients with idiopathic normal pressure hydrocephalus from shunt surgery. Am J Neuroradiol. 2019;40:74\u20139.","journal-title":"Am J Neuroradiol"},{"key":"677_CR6","doi-asserted-by":"publisher","first-page":"2207","DOI":"10.1007\/s00701-016-2858-5","volume":"158","author":"R Garcia-Armengol","year":"2016","unstructured":"Garcia-Armengol R, Domenech S, Botella-Campos C, Goncalves FJ, Men\u00e9ndez B, Teixidor P, et al. Comparison of elevated intracranial pressure pulse amplitude and disproportionately enlarged subarachnoid space (DESH) for prediction of surgical results in suspected idiopathic normal pressure hydrocephalus. Acta Neurochir. 2016;158:2207\u201313.","journal-title":"Acta Neurochir"},{"key":"677_CR7","doi-asserted-by":"publisher","first-page":"1429","DOI":"10.3174\/ajnr.A7168","volume":"42","author":"HY Park","year":"2021","unstructured":"Park HY, Park CR, Suh CH, Kim MJ, Shim WH, Kim SJ. Prognostic utility of disproportionately enlarged subarachnoid space hydrocephalus in idiopathic normal pressure hydrocephalus treated with ventriculoperitoneal shunt surgery: a systematic review and meta-analysis. Am J Neuroradiol. 2021;42:1429\u201336.","journal-title":"Am J Neuroradiol"},{"key":"677_CR8","doi-asserted-by":"crossref","unstructured":"Thavarajasingam SG, El-Khatib M, Vemulapalli K, Iradukunda HAS, Sajeenth Vishnu K, Borchert R, et al. Radiological predictors of shunt response in the diagnosis and treatment of idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis. Acta Neurochir. 2023.","DOI":"10.1093\/bjs\/znad258.436"},{"key":"677_CR9","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1016\/j.jns.2018.01.017","volume":"387","author":"YJ Hong","year":"2018","unstructured":"Hong YJ, Kim MJ, Jeong E, Kim JE, Hwang J, Lee J, et al. Preoperative biomarkers in patients with idiopathic normal pressure hydrocephalus showing a favorable shunt surgery outcome. J Neurol Sci. 2018;387:21\u20136.","journal-title":"J Neurol Sci"},{"key":"677_CR10","doi-asserted-by":"publisher","first-page":"2311","DOI":"10.3174\/ajnr.A4046","volume":"35","author":"J Virhammar","year":"2014","unstructured":"Virhammar J, Laurell K, Cesarini KG, Larsson EM. Preoperative prognostic value of MRI findings in 108 patients with idiopathic normal pressure hydrocephalus. Am J Neuroradiol. 2014;35:2311\u20138.","journal-title":"Am J Neuroradiol"},{"key":"677_CR11","doi-asserted-by":"publisher","first-page":"1436","DOI":"10.3171\/2016.9.JNS161080","volume":"127","author":"N Shinoda","year":"2017","unstructured":"Shinoda N, Hirai O, Hori S, Mikami K, Bando T, Shimo D, et al. Utility of MRI-based disproportionately enlarged subarachnoid space hydrocephalus scoring for predicting prognosis after surgery for idiopathic normal pressure hydrocephalus: clinical research. J Neurosurg. 2017;127:1436\u201342.","journal-title":"J Neurosurg"},{"key":"677_CR12","doi-asserted-by":"publisher","first-page":"1495","DOI":"10.1007\/s00701-016-2861-x","volume":"158","author":"T Radovnick\u00fd","year":"2016","unstructured":"Radovnick\u00fd T, Ad\u00e1mek D, Derner M, Same\u0161 M. Fractional anisotropy in patients with disproportionately enlarged subarachnoid space hydrocephalus. Acta Neurochir. 2016;158:1495\u2013500.","journal-title":"Acta Neurochir"},{"key":"677_CR13","doi-asserted-by":"publisher","first-page":"1449","DOI":"10.1212\/WNL.0000000000000342","volume":"82","author":"D Jaraj","year":"2014","unstructured":"Jaraj D, Rabiei K, Marlow T, Jensen C, Skoog I, Wikkels\u00f8 C. Prevalence of idiopathic normal-pressure hydrocephalus. Neurology. 2014;82:1449\u201354.","journal-title":"Neurology"},{"key":"677_CR14","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1159\/000357329","volume":"3","author":"K Ishii","year":"2013","unstructured":"Ishii K, Soma T, Shimada K, Oda H, Terashima A, Kawasaki R. Automatic volumetry of the cerebrospinal fluid space in idiopathic normal pressure hydrocephalus. Dement Geriatr Cogn Dis Extra. 2013;3:489\u201396.","journal-title":"Dement Geriatr Cogn Dis Extra"},{"key":"677_CR15","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.clineuro.2017.04.015","volume":"158","author":"N Benedetto","year":"2017","unstructured":"Benedetto N, Gambacciani C, Aquila F, Di Carlo DT, Morganti R, Perrini P. A new quantitative method to assess disproportionately enlarged subarachnoid space (DESH) in patients with possible idiopathic normal pressure hydrocephalus: the SILVER index. Clin Neurol Neurosurg. 2017;158:27\u201332.","journal-title":"Clin Neurol Neurosurg"},{"key":"677_CR16","doi-asserted-by":"publisher","first-page":"e427","DOI":"10.1016\/j.wneu.2023.05.077","volume":"176","author":"S Yamada","year":"2023","unstructured":"Yamada S, Ito H, Matsumasa H, Tanikawa M, Ii S, Otani T, et al. Tightened sulci in the high convexities as a noteworthy feature of idiopathic normal pressure hydrocephalus. World Neurosurg. 2023;176:e427\u201337.","journal-title":"World Neurosurg"},{"key":"677_CR17","doi-asserted-by":"publisher","first-page":"e549","DOI":"10.1212\/WNL.0000000000008673","volume":"94","author":"JE Crook","year":"2020","unstructured":"Crook JE, Gunter JL, Ball CT, Jones DT, Graff-Radford J, Knopman DS, et al. Linear vs volume measures of ventricle size: relation to present and future gait and cognition. Neurology. 2020;94:e549\u201356.","journal-title":"Neurology"},{"key":"677_CR18","doi-asserted-by":"publisher","first-page":"2262","DOI":"10.3174\/ajnr.A4440","volume":"36","author":"S Yamada","year":"2015","unstructured":"Yamada S, Ishikawa M, Yamamot K. Optimal diagnostic indices for idiopathic normal pressure hydrocephalus based on the 3D quantitative volumetric analysis for the cerebral ventricle and subarachnoid space. Am J Neuroradiol. 2015;36:2262\u20139.","journal-title":"Am J Neuroradiol"},{"key":"677_CR19","doi-asserted-by":"publisher","first-page":"903","DOI":"10.1212\/WNL.0b013e31820f2dd0","volume":"76","author":"J Malm","year":"2011","unstructured":"Malm J, Jacobsson J, Birgander R, Eklund A. Reference values for CSF outflow resistance and intracranial pressure in healthy elderly. Neurology. 2011;76:903\u20139.","journal-title":"Neurology"},{"key":"677_CR20","doi-asserted-by":"publisher","first-page":"648","DOI":"10.1038\/jcbfm.2014.241","volume":"35","author":"L Zarrinkoob","year":"2015","unstructured":"Zarrinkoob L, Ambarki K, W\u00e5hlin A, Birgander R, Eklund A, Malm J. Blood flow distribution in cerebral arteries. J Cereb Blood Flow Metab. 2015;35:648\u201354.","journal-title":"J Cereb Blood Flow Metab"},{"key":"677_CR21","doi-asserted-by":"publisher","first-page":"116581","DOI":"10.1016\/j.jns.2019.116581","volume":"408","author":"P Ryska","year":"2020","unstructured":"Ryska P, Slezak O, Eklund A, Malm J, Salzer J, Zizka J. Radiological markers of idiopathic normal pressure hydrocephalus: relative comparison of their diagnostic performance. J Neurol Sci. 2020;408:116581.","journal-title":"J Neurol Sci"},{"key":"677_CR22","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1227\/01.NEU.0000168185.29659.C5","volume":"57","author":"N Relkin","year":"2005","unstructured":"Relkin N, Marmarou A, Klinge P, Bergsneider M, Black PML. INPH guidelines, part II: diagnosing idiopathic normal pressure hydrocephalus. Neurosurgery. 2005;57:4\u201316.","journal-title":"Neurosurgery"},{"key":"677_CR23","unstructured":"Friston KJ, Ashburner JT, Kiebel SJ, Nicholas TE, Penny WD. Statistical parametric Mappin: The Analysis of Functional Brain Images. 2007."},{"key":"677_CR24","doi-asserted-by":"publisher","first-page":"947","DOI":"10.1109\/42.650892","volume":"16","author":"BA Ardekani","year":"1997","unstructured":"Ardekani BA, Kershaw J, Braun M, Kanno I. Automatic detection of the mid-sagittal plane in 3-D brain images. IEEE Trans Mes Imaging. 1997;16:947\u201352.","journal-title":"IEEE Trans Mes Imaging"},{"key":"677_CR25","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1016\/j.neuroimage.2009.02.030","volume":"46","author":"BA Ardekani","year":"2009","unstructured":"Ardekani BA, Bachman AH. Model-based automatic detection of the anterior and posterior commissures on MRI scans. Neuroimage. 2009;46:677\u201382.","journal-title":"Neuroimage"},{"key":"677_CR26","doi-asserted-by":"crossref","unstructured":"Ardekani B. A new approach to symmetric registration of longitudinal structural MRI of the human brain. bioRxiv. 2018.\u00a0","DOI":"10.1101\/306811"},{"key":"677_CR27","unstructured":"Axelsson J, Behndig S. qDESH GitHub. https:\/\/github.com\/SofiaBehndig\/qDESH"},{"key":"677_CR28","doi-asserted-by":"publisher","first-page":"1831","DOI":"10.3174\/ajnr.A4838","volume":"37","author":"W Narita","year":"2016","unstructured":"Narita W, Nishio Y, Baba T, Iizuka O, Ishihara T, Matsuda M, et al. High-convexity tightness predicts the shunt response in idiopathic normal pressure hydrocephalus. Am J Neuroradiol. 2016;37:1831\u20137.","journal-title":"Am J Neuroradiol"},{"key":"677_CR29","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1007\/s00234-007-0318-x","volume":"50","author":"M Sasaki","year":"2008","unstructured":"Sasaki M, Honda S, Yuasa T, Iwamura A, Shibata E, Ohba H. Narrow CSF space at high convexity and high midline areas in idiopathic normal pressure hydrocephalus detected by axial and coronal MRI. Neuroradiology. 2008;50:117\u201322.","journal-title":"Neuroradiology"},{"key":"677_CR30","unstructured":"Alvarez Tolado N, Munakomi S, Prestigacomo CJ. Neuroanatomy, Sylvian Fissure. StatPearls. 2023. https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK574552\/"},{"key":"677_CR31","unstructured":"Axelsson J. imlook4d. https:\/\/sites.google.com\/site\/imlook4d\/"},{"key":"677_CR32","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1148\/116.1.85","volume":"116","author":"MS Huckman","year":"1975","unstructured":"Huckman MS, Fox J, Topel J. The validity of criteria for the evaluation of cerebral atrophy by computed tomography. Radiology. 1975;116:85\u201392.","journal-title":"Radiology"},{"key":"677_CR33","doi-asserted-by":"publisher","first-page":"749","DOI":"10.1093\/brain\/100.4.749","volume":"100","author":"L Gunasekera","year":"1977","unstructured":"Gunasekera L, Richardson AE. Computerized axial tomography in idiopathic hydrocephalus. Brain. 1977;100:749\u201354.","journal-title":"Brain"},{"key":"677_CR34","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1743-8454-7-18","volume":"7","author":"M Hashimoto","year":"2010","unstructured":"Hashimoto M, Ishikawa M, Mori E, Kuwana N. Diagnosis of idiopathic normal pressure hydrocephalus is supported by MRI-based scheme: a prospective cohort study. Cerebrospinal Fluid Res. 2010;7:1\u201311.","journal-title":"Cerebrospinal Fluid Res"},{"key":"677_CR35","doi-asserted-by":"publisher","first-page":"1249","DOI":"10.3174\/ajnr.A4695","volume":"37","author":"S Yamada","year":"2016","unstructured":"Yamada S, Ishikawa M, Yamamoto K. Comparison of CSF distribution between idiopathic normal pressure hydrocephalus and Alzheimer disease. Am J Neuroradiol. 2016;37:1249\u201355.","journal-title":"Am J Neuroradiol"},{"key":"677_CR36","doi-asserted-by":"publisher","first-page":"2691","DOI":"10.1093\/brain\/awx191","volume":"140","author":"G Ringstad","year":"2017","unstructured":"Ringstad G, Vatnehol SAS, Eide PK. Glymphatic MRI in idiopathic normal pressure hydrocephalus. Brain. 2017;140:2691\u2013705.","journal-title":"Brain"},{"key":"677_CR37","doi-asserted-by":"crossref","unstructured":"Yamada S, Ito H, Matsumasa H, Ii S, Otani T, Tanikawa M, et al. Automatic assessment of disproportionately enlarged subarachnoid-space hydrocephalus from 3D MRI using two deep learning models. Front Aging Neurosci. 2024.","DOI":"10.3389\/fnagi.2024.1362637"}],"container-title":["Fluids and Barriers of the CNS"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12987-025-00677-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12987-025-00677-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12987-025-00677-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T02:03:37Z","timestamp":1751421817000},"score":1,"resource":{"primary":{"URL":"https:\/\/fluidsbarrierscns.biomedcentral.com\/articles\/10.1186\/s12987-025-00677-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,1]]},"references-count":37,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["677"],"URL":"https:\/\/doi.org\/10.1186\/s12987-025-00677-2","relation":{},"ISSN":["2045-8118"],"issn-type":[{"value":"2045-8118","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,1]]},"assertion":[{"value":"29 November 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 June 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 July 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the institutional review board at Ume\u00e5 University (Dnr. 2017\/252\u201331). All subjects provided written and oral informed consent in accordance with the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"67"}}