{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T22:56:37Z","timestamp":1793141797869,"version":"4.5.0"},"reference-count":40,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T00:00:00Z","timestamp":1641859200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Aging Neurosci."],"abstract":"<jats:p>With an ever-growing aging population, the prevalence of normal pressure hydrocephalus (NPH) is increasing. Clinical symptoms of NPH include cognitive impairment, gait disturbance, and urinary incontinence. Surgery can improve symptoms, which leads to the disease's alternative name: treatable dementia. The Evans index (EI), defined as the ratio of the maximal width of the frontal horns to the maximum inner skull diameter, is the most commonly used index to indirectly assess the condition of the ventricles in NPH patients. EI measurement is simple, fast, and does not require any special software; in clinical practice, an EI &amp;gt;0.3 is the criterion for ventricular enlargement. However, EI's measurement methods, threshold setting, correlation with ventricle volume, and even its clinical value has been questioned. Based on the EI, the z-EI and anteroposterior diameter of the lateral ventricle index were derived and are discussed in this review.<\/jats:p>","DOI":"10.3389\/fnagi.2021.783092","type":"journal-article","created":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T00:46:55Z","timestamp":1641862015000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":76,"title":["Application of Evans Index in Normal Pressure Hydrocephalus Patients: A Mini Review"],"prefix":"10.3389","volume":"13","author":[{"given":"Xi","family":"Zhou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Xia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,1,11]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1056\/NEJM196507152730301","article-title":"Symptomatic occult hydrocephalus with normal cerebrospinal-fluid pressure. A treatable syndrome","volume":"273","author":"Adams","year":"1965","journal-title":"N. Engl. J. Med."},{"key":"B2","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1227\/01.NEU.0000370939.30003.D1","article-title":"Brain ventricular size in healthy elderly: comparison between Evans index and volume measurement","volume":"67","author":"Ambarki","year":"2010","journal-title":"Neurosurgery"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e217705","DOI":"10.1371\/journal.pone.0217705","article-title":"Prevalence of idiopathic normal pressure hydrocephalus: a prospective, population-based study","volume":"14","author":"Andersson","year":"2019","journal-title":"PLoS ONE"},{"key":"B4","doi-asserted-by":"publisher","first-page":"806","DOI":"10.1136\/jnnp-2013-306117","article-title":"Natural course of idiopathic normal pressure hydrocephalus","volume":"85","author":"Andren","year":"2014","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e462","DOI":"10.1097\/SCS.0000000000002779","article-title":"Feasibility of simple linear measurements to determine ventricular enlargement in patients with idiopathic normal pressure hydrocephalus","volume":"27","author":"Bao","year":"2016","journal-title":"J. Craniofac. Surg."},{"key":"B6","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1016\/j.ejrad.2017.07.013","article-title":"The Evans' Index revisited: new cut-off levels for use in radiological assessment of ventricular enlargement in the elderly","volume":"95","author":"Brix","year":"2017","journal-title":"Eur. J. Radiol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1871","DOI":"10.1109\/TBME.2017.2783305","article-title":"Learning based segmentation of CT brain images: application to postoperative hydrocephalic scans","volume":"65","author":"Cherukuri","year":"2018","journal-title":"IEEE Trans. Biomed. Eng."},{"key":"B8","doi-asserted-by":"publisher","first-page":"e549","DOI":"10.1212\/WNL.0000000000008673","article-title":"Linear vs volume measures of ventricle size: relation to present and future gait and cognition","volume":"94","author":"Crook","year":"2020","journal-title":"Neurology"},{"key":"B9","doi-asserted-by":"publisher","first-page":"294","DOI":"10.3389\/fnagi.2019.00294","article-title":"The ventricular system enlarges abnormally in the seventies, earlier in men, and first in the frontal horn: a study based on more than 3,000 scans","volume":"11","author":"Curra","year":"2019","journal-title":"Front. Aging Neurosci."},{"key":"B10","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1016\/j.clineuro.2018.03.021","article-title":"Inverse relationship between the evans index and cognitive performance in non-disabled, stroke-free, community-dwelling older adults. A population-based study","volume":"169","author":"Del","year":"2018","journal-title":"Clin Neurol Neurosurg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"101698","DOI":"10.1016\/j.media.2020.101698","article-title":"Multi-atlas image registration of clinical data with automated quality assessment using ventricle segmentation","volume":"63","author":"Dubost","year":"2020","journal-title":"Med. Image Anal."},{"key":"B12","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1186\/s12987-018-0090-9","article-title":"Paradigm-shift: radiological changes in the asymptomatic iNPH-patient to be: an observational study","volume":"15","author":"Engel","year":"2018","journal-title":"Fluids Barriers CNS"},{"key":"B13","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1001\/archneurpsyc.1942.02290060069004","article-title":"An encephalographic ratio for estimating ventricular enlargement and cerebral atrophy","volume":"47","author":"Evans","year":"1942","journal-title":"Arch. Neurol. Psychiatry"},{"key":"B14","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1007\/s00234-020-02361-8","article-title":"A new index for assessing cerebral ventricular volume in idiopathic normal-pressure hydrocephalus: a comparison with Evans' index","volume":"62","author":"He","year":"2020","journal-title":"Neuroradiology"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1923","DOI":"10.1007\/s11548-019-02038-5","article-title":"Fully automated intracranial ventricle segmentation on CT with 2D regional convolutional neural network to estimate ventricular volume","volume":"14","author":"Huff","year":"2019","journal-title":"Int. J. Comput. Assist. Radiol. Surg."},{"key":"B16","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1016\/j.jns.2014.01.033","article-title":"Incidence of idiopathic normal pressure hydrocephalus (iNPH): a 10-year follow-up study of a rural community in Japan","volume":"339","author":"Iseki","year":"2014","journal-title":"J. Neurol. Sci."},{"key":"B17","doi-asserted-by":"publisher","first-page":"2678","DOI":"10.1007\/s00330-008-1044-4","article-title":"Clinical impact of the callosal angle in the diagnosis of idiopathic normal pressure hydrocephalus","volume":"18","author":"Ishii","year":"2008","journal-title":"Eur. Radiol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"592","DOI":"10.1212\/WNL.0000000000002369","article-title":"Vascular factors in suspected normal pressure hydrocephalus: a population-based study","volume":"86","author":"Jaraj","year":"2016","journal-title":"Neurology"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1449","DOI":"10.1212\/WNL.0000000000000342","article-title":"Prevalence of idiopathic normal-pressure hydrocephalus","volume":"82","author":"Jaraj","year":"2014","journal-title":"Neurology"},{"key":"B20","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1111\/ene.13226","article-title":"Estimated ventricle size using Evans index: reference values from a population-based sample","volume":"24","author":"Jaraj","year":"","journal-title":"Eur. J. Neurol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"850","DOI":"10.1016\/j.jalz.2017.01.013","article-title":"Mortality and risk of dementia in normal-pressure hydrocephalus: a population study","volume":"13","author":"Jaraj","year":"","journal-title":"Alzheimers. Dement."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1051","DOI":"10.1016\/j.neuroimage.2011.06.080","article-title":"A comprehensive testing protocol for MRI neuroanatomical segmentation techniques: evaluation of a novel lateral ventricle segmentation method","volume":"58","author":"Kempton","year":"2011","journal-title":"Neuroimage"},{"key":"B23","doi-asserted-by":"publisher","first-page":"18203","DOI":"10.1038\/s41598-020-75381-2","article-title":"Wide temporal horns are associated with cognitive dysfunction, as well as impaired gait and incontinence","volume":"10","author":"Lilja-Lund","year":"2020","journal-title":"Sci. Rep."},{"key":"B24","doi-asserted-by":"publisher","first-page":"889","DOI":"10.2174\/1573405616666201223150004","article-title":"The differential diagnostic value of the callosal angle and Evans index in mild cognitive impairment and Alzheimer's disease","volume":"17","author":"Liu","year":"2020","journal-title":"Curr Med Imaging"},{"key":"B25","doi-asserted-by":"publisher","first-page":"197","DOI":"10.1148\/radiol.2017161216","article-title":"Diagnosis of normal-pressure hydrocephalus: use of traditional measures in the era of volumetric MR imaging","volume":"285","author":"Miskin","year":"2017","journal-title":"Radiology"},{"key":"B26","doi-asserted-by":"publisher","first-page":"775","DOI":"10.2176\/nmc.52.775","article-title":"Guidelines for management of idiopathic normal pressure hydrocephalus: second edition","volume":"52","author":"Mori","year":"2012","journal-title":"Neurol. Med. Chir. (Tokyo)"},{"key":"B27","doi-asserted-by":"publisher","first-page":"63","DOI":"10.2176\/nmc.st.2020-0292","article-title":"Guidelines for Management of Idiopathic Normal Pressure Hydrocephalus (Third Edition): endorsed by the Japanese Society of Normal Pressure Hydrocephalus","volume":"61","author":"Nakajima","year":"2021","journal-title":"Neurol. Med. Chir. (Tokyo)"},{"key":"B28","doi-asserted-by":"publisher","first-page":"1187","DOI":"10.3174\/ajnr.A6620","article-title":"Ventricular volume is more strongly associated with clinical improvement than the evans index after shunting in idiopathic normal pressure hydrocephalus","volume":"41","author":"Neikter","year":"2020","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1007\/s12021-021-09510-1","article-title":"Improved segmentation of the intracranial and ventricular volumes in populations with cerebrovascular lesions and atrophy using 3D CNNs","volume":"19","author":"Ntiri","year":"2021","journal-title":"Neuroinformatics"},{"key":"B30","doi-asserted-by":"publisher","first-page":"5300","DOI":"10.1007\/s00330-020-07555-5","article-title":"Diagnostic performance and interobserver agreement of the callosal angle and Evans' index in idiopathic normal pressure hydrocephalus: a systematic review and meta-analysis","volume":"31","author":"Park","year":"2021","journal-title":"Eur. Radiol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"S4","DOI":"10.1227\/01.NEU.0000168185.29659.C5","article-title":"Diagnosing idiopathic normal-pressure hydrocephalus","volume":"57","author":"Relkin","year":"2005","journal-title":"Neurosurgery"},{"key":"B32","doi-asserted-by":"publisher","first-page":"1201","DOI":"10.3174\/ajnr.A7095","article-title":"Variability of normal pressure hydrocephalus imaging biomarkers with respect to section plane angulation: how wrong a radiologist can be?","volume":"42","author":"Ryska","year":"2021","journal-title":"AJNR Am. J. Neuroradiol"},{"key":"B33","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.1016\/j.wneu.2021.02.108","article-title":"The utility of imaging parameters in predicting long-term clinical improvement after shunt surgery in patients with idiopathic normal pressure hydrocephalus","volume":"149","author":"Subramanian","year":"2021","journal-title":"World Neurosurg."},{"key":"B34","doi-asserted-by":"publisher","first-page":"121","DOI":"10.5114\/fn.2015.52408","article-title":"Original article analysis of intracranial volume ratios by means of cerebrospinal fluid deployment indicators","volume":"2","author":"Szczepek","year":"2015","journal-title":"Folia Neuropathologica"},{"key":"B35","doi-asserted-by":"publisher","first-page":"939","DOI":"10.1227\/NEU.0b013e318208f5e0","article-title":"Evans' index revisited: the need for an alternative in normal pressure hydrocephalus","volume":"68","author":"Toma","year":"2011","journal-title":"Neurosurgery"},{"key":"B36","doi-asserted-by":"publisher","first-page":"130","DOI":"10.3171\/2017.8.JNS17547","article-title":"Increase in callosal angle and decrease in ventricular volume after shunt surgery in patients with idiopathic normal pressure hydrocephalus","volume":"130","author":"Virhammar","year":"2018","journal-title":"J. Neurosurg."},{"key":"B37","doi-asserted-by":"publisher","first-page":"17318","DOI":"10.1038\/s41598-019-53888-7","article-title":"Longitudinal morphological changes during recovery from brain deformation due to idiopathic normal pressure hydrocephalus after ventriculoperitoneal shunt surgery","volume":"9","author":"Yamada","year":"2019","journal-title":"Sci. Rep."},{"key":"B38","doi-asserted-by":"publisher","first-page":"2262","DOI":"10.3174\/ajnr.A4440","article-title":"Optimal diagnostic indices for idiopathic normal pressure hydrocephalus based on the 3d quantitative volumetric analysis for the cerebral ventricle and subarachnoid space","volume":"36","author":"Yamada","year":"2015","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"B39","doi-asserted-by":"publisher","first-page":"1249","DOI":"10.3174\/ajnr.A4695","article-title":"Comparison of CSF distribution between idiopathic normal pressure hydrocephalus and Alzheimer disease","volume":"37","author":"Yamada","year":"2016","journal-title":"AJNR Am. J. Neuroradiol."},{"key":"B40","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1111\/ane.13182","article-title":"A systematic review on the epidemiology of normal pressure hydrocephalus","volume":"141","author":"Zaccaria","year":"2020","journal-title":"Acta Neurol. Scand."}],"container-title":["Frontiers in Aging Neuroscience"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnagi.2021.783092\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,1,11]],"date-time":"2022-01-11T00:46:58Z","timestamp":1641862018000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fnagi.2021.783092\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,1,11]]},"references-count":40,"alternative-id":["10.3389\/fnagi.2021.783092"],"URL":"https:\/\/doi.org\/10.3389\/fnagi.2021.783092","relation":{},"ISSN":["1663-4365"],"issn-type":[{"value":"1663-4365","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,1,11]]},"article-number":"783092"}}