Which imaging features do you use when considering Normal Pressure Hydrocephalus to decide whether to proceed with large-volume LP or lumbar drain trial?

At our center, we follow the approach of the NPH clinic at the Imperial College Hospital in London.

See this excellent review article for further details: Carswell, PMID 36162853.

Starting with clinical suspicion for NPH (gait apraxia, FOG +/- urinary incontinence and cognitive decline, imaging should have many of the features enumerated in the iNPH rad scale, acute callosal angle, crowded convexity on coronal views, enlarged ventricles with transependymal flow, DESH, etc. (K...

I personally use the iNPH rad scale based on the prior MDS talks I've attended, but your mileage may vary.