Assessment Lumboperitoneal or Ventriculoperitoneal Shunt Patency by Radionuclide Technique: A Review Experience Cases

Abstract

Hydrocephalus-related symptoms that worsen after shunt placement may indicate a malfunctioning or obstructed shunt. The assessment of shunt patency and site of obstruction is important for planning of treatment. The radionuclide cerebrospinal fluid (CSF) shunt study provides a simple, effective, and low-radiation-dose method of assessing CSF shunt patency. The radionuclide CSF shuntography is a useful tool in the management of patients presenting with shunt-related problems not elucidated by conventional radiological examination. This article described the imaging technique of ventriculoperitoneal (VP) shunt and lumbar puncture (LP) shunt. The normal finding, abnormal finding of completed obstruction and partial obstruction is present by our cases experience. The radiopharmaceutical (Tc-99m diethylenetriaminepentaacetic acid) was injected via the reservoir for VP shunt and via lumbar puncture needle in subarachnoid space for LP shunt, then serial image in the head and abdominal area.The normal function of VP and LP shunt usually rapid spillage of the radioactivity in the abdominal cavity diffusely. The patent proximal tube VP shunt demonstrates ventricular reflux. The early image of patent LP shunt reveals no activity in the ventricular system contrast to distal LP shunt reveals early reflux of activity in the ventricular system. The completed distal VP and LP shunt obstruction show absence of tracer in the peritoneal area or markedly delayed appearance of abdominal activity. The partial distal VP and LP shunt obstruction recognized by slow transit or accumulation of tracer at the distal end or focal tracer in the peritoneal cavity near the tip of distal shunt. The images of the normal and abnormal CSF shunt as describe before are present in the full paper. Radionuclide CSF shuntography is a reliable and simple procedure for assessment shunt patency.

Attachment of a pressure gradient chamber to existing lumbar theco-peritoneal shunt in a patient with pseudotumor cerebri with low pressure headaches, a novel procedure: a case report

“…The conventional thecoperitoneal shunt are valve-less and had the major disadvantage of adjusting the CSF flow. 9,10 Patients with these shunts frequently experienced over-drainage symptoms.…”

Validity of Shunt Pumping Test as a Screening Modality for Shunt Block: An Experimental Study

“…Radionuclide imaging has been used to detect the flow of shunt, and its efficacy has been evaluated in conjunction with NCCT of the head. [7][8][9] NCCT of the head has been reported to have a sensitivity of 77.8% and specificity of 66.7%. Shuntogram has been found to have sensitivity of 92.6% and specificity of 59.5%.…”

Advanced Neuroimaging Techniques in Pediatric Hydrocephalus

“…Thus, ultrasound is best used as a screening or surveillance test in the evaluation and follow-up of pediatric hydrocephalus before or after treatment typically early in life when the anterior fontanelle is patent [18] . or not a shunt is patent [20] . The study itself requires the use of the radiopharmaceutical 99m Tc-diethylenetriaminepentaacetic acid (DTPA) [21] .…”

“…This tracer is injected into the shunt reservoir, and serial imaging demonstrating movement of DTPA from proximal to distal locations is obtained. The normal function of the shunt is the rapid emission of the tracer into the body cavity where the distal catheter resides, while a patent proximal system demonstrates ventricular reflux [20] . The sensitivity, specificity, and accuracy of the radionuclide shuntogram have been described to be as high as 97, 90, and 93%, respectively, in a study by Graham et al [22] that included the analysis of 192 radionuclide CSF shunt studies.…”