Radioisotope shuntograms at the Children’s Hospital of Eastern Ontario

Vassilyadi, Michael; Tataryn, Zac; Matzinger, Mary Ann; Briggs, Valerie; Ventureyra, Enrique C. G.

doi:10.1007/s00381-005-1153-1

Cited by 20 publications

(9 citation statements)

References 13 publications

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“…The sensitivity, specificity, accuracy, positive and negative predictive values in our study were higher than that reported by Vassilyadi et al [7] who found in their study of 68 shuntograms that sensitivity of shuntograms is 62.9%, specificity 81.1%, accuracy 71.2%, positive predictive value 70.8% and negative predictive value 75%.…”

Section: Using Radionuclide Shuntogram Onlycontrasting

confidence: 81%

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The Additive Value of Radionuclide Shuntogram to Computed Tomography in Evaluation of CSF Shunts

Mohabatkar¹

2015

JNSK

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Background: Placement of cerebrospinal fluid diversions or shunts, is a common neurosurgical procedure indicated for a wide spectrum of conditions impeding the normal flow of cerebrospinal fluid (CSF). The most common systems employed are ventriculoperitoneal, ventriculoatrial and lumboperitoneal shunts. Management of patients with surgically treated hydrocephalus may be challenging, as the clinical presentation of a malfunctioning shunt is often nonspecific, especially in young children. Moreover, conventional radiological examinations, such as shunt series, cerebral ultrasound or CT scans, are sometimes equivocal in diagnosing cases of shunt malfunction, also in determining the site of obstruction. Thus, numerous procedures have been proposed to ascertain shunt function, and localize site of obstruction. Injection of contrast media and radionuclide directly into the shunt device into the lateral ventricles is one of the most common techniques employed, to assist in evaluating shunt function.

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Section: Using Radionuclide Shuntogram Onlycontrasting

confidence: 81%

“…However, Shuntograms have been reported to have falsenegative rates ranging 2-36% [7]. Also it has been observed that sensitivity was increased with CT and CSF shuntogram compared with CT alone [8].…”

Section: Research Articlementioning

confidence: 99%

The Additive Value of Radionuclide Shuntogram to Computed Tomography in Evaluation of CSF Shunts

Mohabatkar¹

2015

JNSK

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“…[7] reported in Table 2. Although all patients are initially lying down when the tracer is being administered, that same position may not be maintained for the duration of the study.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2014

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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.

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“…This method also did not analyze the pulsatile nature of CSF flow dynamics and exposed the patient to repeated doses of radiation. 1,4,11,18 MRI techniques allow the study of the pulsatile nature of CSF flow, but they provide data during a single cardiac cycle as opposed to continuous monitoring. Furthermore, MRI continues to be an expensive and time-consuming study that is not well tolerated by many patients due to claustrophobia.…”

Section: Discussionmentioning

confidence: 99%

Noninvasive measurement of cerebrospinal fluid flow using an ultrasonic transit time flow sensor: a preliminary study

Pennell

Kaufman

et al. 2016

PED

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OBJECT Mechanical failure—which is the primary cause of CSF shunt malfunction—is not readily diagnosed, and the specific reasons for mechanical failure are not easily discerned. Prior attempts to measure CSF flow noninvasively have lacked the ability to either quantitatively or qualitatively obtain data. To address these needs, this preliminary study evaluates an ultrasonic transit time flow sensor in pediatric and adult patients with external ventricular drains (EVDs). One goal was to confirm the stated accuracy of the sensor in a clinical setting. A second goal was to observe the sensor’s capability to record real-time continuous CSF flow. The final goal was to observe recordings during instances of flow blockage or lack of flow in order to determine the sensor’s ability to identify these changes. METHODS A total of 5 pediatric and 11 adult patients who had received EVDs for the treatment of hydrocephalus were studied in a hospital setting. The primary EVD was connected to a secondary study EVD that contained a fluid-filled pressure transducer and an in-line transit time flow sensor. Comparisons were made between the weight of the drainage bag and the flow measured via the sensor in order to confirm its accuracy. Data from the pressure transducer and the flow sensor were recorded continuously at 100 Hz for a period of 24 hours by a data acquisition system, while the hourly CSF flow into the drip chamber was recorded manually. Changes in the patient’s neurological status and their time points were noted. RESULTS The flow sensor demonstrated a proven accuracy of ± 15% or ± 2 ml/hr. The flow sensor allowed real-time continuous flow waveform data recordings. Dynamic analysis of CSF flow waveforms allowed the calculation of the pressure-volume index. Lastly, the sensor was able to diagnose a blocked catheter and distinguish between the blockage and lack of flow. CONCLUSIONS The Transonic flow sensor accurately measures CSF output within ± 15% or ± 2 ml/hr, diagnoses the blockage or lack of flow, and records real-time continuous flow data in patients with EVDs. Calculations of a wide variety of diagnostic parameters can be made from the waveform recordings, including resistance and compliance of the ventricular catheters and the compliance of the brain. The sensor’s clinical applications may be of particular importance to the noninvasive diagnosis of shunt malfunctions with the development of an implantable device.

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Radioisotope shuntograms at the Children’s Hospital of Eastern Ontario

Cited by 20 publications

References 13 publications

The Additive Value of Radionuclide Shuntogram to Computed Tomography in Evaluation of CSF Shunts

The Additive Value of Radionuclide Shuntogram to Computed Tomography in Evaluation of CSF Shunts

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

Noninvasive measurement of cerebrospinal fluid flow using an ultrasonic transit time flow sensor: a preliminary study

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