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目的:探求特发性正常压力脑积水（iNPH）患者的脑白质病变与脑脊液放液试验结果及临床特征的关系。方法:回顾性分析2014年至2019年北京协和医院神经科门诊就诊和病房住院的iNPH患者。所有患者都经过详细的神经心理学及行走能力的评估，头磁共振检查和脑脊液放液试验。应用Fazekas评分以及弥散张量技术，比较脑脊液放液试验阳性和阴性组患者的脑白质病变的不同。分析感兴趣区的弥散张量成像技术相关参数各向异性分数（FA）、平均扩散率（MD）与iNPH患者临床特征的相关性。结果:43例iNPH患者（男∶女为29∶14，年龄52~79岁）被纳入本研究。脑脊液放液试验结果阳性组和阴性组患者相比，倾向于有更高的侧脑室周围白质Fazekas评分［2.5（1.0，3.0）分比1.0（1.0，2.0）分n U=108.00，n P=0.033］，更高的左侧侧脑室后角旁MD值［（1.14±0.27）×10n -9 mmn 2/s 比（0.85±0.08）×10n -9 mmn 2/s，n P=0.003］，更低的右侧侧脑室前角旁FA值［（0.20±0.07）比（0.27±0.09），n P=0.058］，更高的右侧侧脑室后角旁MD值［（1.17±0.34）×10n -9 mmn 2/s比（0.95±0.01）×10n -9 mmn 2/s，n P=0.003］。双侧侧脑室前角旁白质FA、MD值与运动功能、认知及功能评分、特发性正常压力脑积水评分（iNPHGS评分）均相关（均n P<0.05）。n 结论:脑白质病变可能是iNPH临床症状的发病机制之一，是通过引流手术可以逆转的病理变化，较多的脑白质病变不应是引流手术的排除指征。“,”Objective:To explore the relationship between white matter lesions and clinical features and response of cerebral spinal fluid (CSF) tap test in patients with idiopathic normal pressure hydrocephalus(iNPH).Methods:Possible iNPH patients were enrolled from outpatients and inpatients in Peking Union Medical College Hospital between 2014 and 2019. All patients underwent detailed neuropsychological and walking assessments, CSF tap test, as well as head magnetic resonance imaging. The Fazekas score of white matter lesions, the fractional anisotropy (FA)and mean diffusivity (MD) values of regions of interest by means ofdiffusion tensor imaging (DTI) were compared between CSF tap test positive and negative response groups. The correlation between DTI parameters and clinical characteristics was analyzed.Results:Forty-three patients (29 male and 14 female, age range: 52-79 years] wererecruited.Compared with the negative group, patients in the positive group tended to have higher Fazekas score of periventricular white matter(n U=108.00, n P=0.03), higher MD value of the region near anterior horn of left lateral ventricles[(1.14±0.27)×10n -9mmn 2/s vs (0.85±0.08) ×10n -9mmn 2/s, n P=0.003], lower FA value of the region near anterior horn of the right lateral ventricles[(0.20±0.07)vs(0.27±0.09), n P=0.058], and higher MD value near the posterior horn of right lateral ventricle [(1.17±0.34)×10n -9mmn 2/s vs (0.95±0.01)×10n -9mmn 2/s, n P=0.003]. FA and MD were significantly correlated with motor function, cognitive and functional scores, and iNPH grading scale (iNPHGS) scores(all n P<0.05).n Conclusions:The white matter lesions might be one of the pathogeneses of lNPH and apathological changewhich can be reversed by CSF drainage. More white matter lesions should not be the contraindication of CSF drainage surgery.