Deep medullary veins score is associated with idiopathic normal pressure hydrocephalus in patients with arteriolosclerotic cerebral small vessel disease.

OBJECTIVE: This study aimed to investigate the association between deep medullary veins (DMVs) score and comorbid idiopathic normal pressure hydrocephalus (iNPH) in patients with arteriolosclerotic cerebral small vessel disease (aCSVD), and to analyze its role as an independent associated factor. METHODS: A total of 80 patients with aCSVD, 40 patients with arteriolosclerotic cerebral small vessel disease comorbid with idiopathic normal pressure hydrocephalus (aCSVD-iNPH), and 30 healthy controls were enrolled. All participants underwent 3.0-T brain MRI to assess DMVs score, periventricular white matter hyperintensity (PVWMH) volume, deep white matter hyperintensity (DWMH) volume, lacunes, cerebral microbleeds, and total CSVD burden score. Clinical and laboratory data were also collected. Multivariate logistic regression was used to identify independent associated factors, and receiver operating characteristic (ROC) curves were employed to evaluate the discriminative ability of the identified factors for group allocation. RESULTS: The DMVs score in the aCSVD-iNPH group (15.29 ± 3.67) was significantly higher than that in the aCSVD group (11.73 ± 2.83) and the healthy control group (11.57 ± 1.79) (P < 0.001). Multivariate logistic regression showed that DMVs score (OR = 1.499, 95%CI: 1.212-1.855, P < 0.001) and PVWMH volume (OR = 1.070, 95%CI: 1.018-1.124,P = 0.007) were independent associated factors for aCSVD-iNPH. The combined model incorporating both DMVs score and PVWMH volume achieved a higher area under the ROC curve (0.863) than either indicator alone, with a sensitivity of 72.5% and a specificity of 90.0%. CONCLUSION: Elevated DMVs score is associated with comorbid iNPH in aCSVD patients and serves as an independent associated factor. The combination of DMVs score and PVWMH volume may represent a promising imaging biomarker for identifying individuals with aCSVD-iNPH, pending prospective validation.