{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:55:34Z","timestamp":1791910534311,"version":"4.3.4"},"reference-count":39,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T00:00:00Z","timestamp":1719964800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"University of Bonn","award":["2024063053000495"],"award-info":[{"award-number":["2024063053000495"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>The aim of this study was to employ artificial intelligence (AI)-based magnetic resonance imaging (MRI) brain volumetry to potentially distinguish between idiopathic normal pressure hydrocephalus (iNPH), Alzheimer\u2019s disease (AD), and age- and sex-matched healthy controls (CG) by evaluating cortical, subcortical, and ventricular volumes. Additionally, correlations between the measured brain and ventricle volumes and two established semi-quantitative radiologic markers for iNPH were examined. An IRB-approved retrospective analysis was conducted on 123 age- and sex-matched subjects (41 iNPH, 41 AD, and 41 controls), with all of the iNPH patients undergoing routine clinical brain MRI prior to ventriculoperitoneal shunt implantation. Automated AI-based determination of different cortical and subcortical brain and ventricular volumes in mL, as well as calculation of population-based normalized percentiles according to an embedded database, was performed; the CE-certified software mdbrain v4.4.1 or above was used with a standardized T1-weighted 3D magnetization-prepared rapid gradient echo (MPRAGE) sequence. Measured brain volumes and percentiles were analyzed for between-group differences and correlated with semi-quantitative measurements of the Evans\u2019 index and corpus callosal angle: iNPH patients exhibited ventricular enlargement and changes in gray and white matter compared to AD patients and controls, with the most significant differences observed in total ventricular volume (+67%) and the lateral (+68%), third (+38%), and fourth (+31%) ventricles compared to controls. Global ventriculomegaly and marked white matter reduction with concomitant preservation of gray matter compared to AD and CG were characteristic of iNPH, whereas global and frontoparietally accentuated gray matter reductions were characteristic of AD. Evans\u2019 index and corpus callosal angle differed significantly between the three groups and moderately correlated with the lateral ventricular volumes in iNPH patients [Evans\u2019 index (r &gt; 0.83, p \u2264 0.001), corpus callosal angle (r &lt; \u22120.74, p \u2264 0.001)]. AI-based MRI volumetry in iNPH patients revealed global ventricular enlargement and focal brain atrophy, which, in contrast to healthy controls and AD patients, primarily involved the supratentorial white matter and was marked temporomesially and in the midbrain, while largely preserving gray matter. Integrating AI volumetry in conjunction with traditional radiologic measures could enhance iNPH identification and differentiation, potentially improving patient management and therapy response assessment.<\/jats:p>","DOI":"10.3390\/diagnostics14131422","type":"journal-article","created":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T06:04:18Z","timestamp":1719986658000},"page":"1422","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Brain and Ventricle Volume Alterations in Idiopathic Normal Pressure Hydrocephalus Determined by Artificial Intelligence-Based MRI Volumetry"],"prefix":"10.3390","volume":"14","author":[{"given":"Zeynep","family":"Bendella","sequence":"first","affiliation":[{"name":"Department of Neuroradiology, Faculty of Medicine, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universit\u00e4t Bonn, 53127 Bonn, Germany"},{"name":"German Center of Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronika","family":"Purrer","sequence":"additional","affiliation":[{"name":"German Center of Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany"},{"name":"Department of Neurodegenerative Diseases, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universit\u00e4t Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Haase","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Faculty of Medicine, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universit\u00e4t Bonn, 53127 Bonn, Germany"},{"name":"German Center of Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Z\u00fclow","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Faculty of Medicine, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universit\u00e4t Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6711-3347","authenticated-orcid":false,"given":"Christine","family":"Kindler","sequence":"additional","affiliation":[{"name":"German Center of Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany"},{"name":"Department of Neurodegenerative Diseases, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universit\u00e4t Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie","family":"Borger","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universit\u00e4t Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7986-5215","authenticated-orcid":false,"given":"Mohammed","family":"Banat","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universit\u00e4t Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franziska","family":"Dorn","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Faculty of Medicine, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universit\u00e4t Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3132-0790","authenticated-orcid":false,"given":"Ullrich","family":"W\u00fcllner","sequence":"additional","affiliation":[{"name":"German Center of Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany"},{"name":"Department of Neurodegenerative Diseases, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universit\u00e4t Bonn, 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Radbruch","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Faculty of Medicine, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universit\u00e4t Bonn, 53127 Bonn, Germany"},{"name":"German Center of Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0985-1517","authenticated-orcid":false,"given":"Frederic Carsten","family":"Schmeel","sequence":"additional","affiliation":[{"name":"Department of Neuroradiology, Faculty of Medicine, University Hospital Bonn, Rheinische Friedrich-Wilhelms-Universit\u00e4t Bonn, 53127 Bonn, Germany"},{"name":"German Center of Neurodegenerative Diseases (DZNE), 53127 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,7,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1056\/NEJM196507152730301","article-title":"Symptomatic occult hydrocephalus with \u201cnormal\u201d cerebrospinal-fluid pressure: A treatable syndrome","volume":"273","author":"Adams","year":"1965","journal-title":"N. 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