Neurosurgery 96:1386–1396, 2025
This study used AI and SHAP analysis to identify five key, easily measurable 1-D neuroimaging biomarkers—FTHR, MEI, MCMI, SMLH, and CPCA—for accurately diagnosing adult non-normal pressure hydrocephalus, offering a practical, standardized, and interpretable approach to improve early detection and clinical decision-making.
• Hydrocephalus diagnosis is often inconsistent due to reliance on clinical and qualitative radiological assessments.
• This study used artificial intelligence (AI) and SHAP analysis to identify key, easily measurable neuroimaging biomarkers for adult non-normal pressure hydrocephalus (non-NPH).
• A comprehensive set of 21 morphometric features was analyzed from MRI images of 42 adult non-NPH patients and 40 healthy controls.
• Gradient Boosting was the best-performing AI classifier, achieving 0.94 accuracy and 0.97 AUC.
• Ventricular volume is the most important biomarker, but measurement is complex for clinicians.
• Five key 1-D biomarkers identified are: frontal-temporal horn ratio (FTHR), modified Evans index (MEI), modified cella media index (MCMI), sagittal maximum lateral ventricle height (SMLH), and coronal posterior callosal angle (CPCA).
• These five markers are easily measurable and provide high diagnostic accuracy, supporting practical clinical use.
• The approach addresses multicollinearity and improves diagnostic standardization, but further validation with larger datasets is needed.
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