The utility of the plain radiograph “shunt series” in the evaluation of suspected ventriculoperitoneal shunt failure in pediatric patients

Desai, Kapil R.; Babb, James S.; Amodio, John

doi:10.1007/s00247-007-0431-3

Cited by 44 publications

(12 citation statements)

References 12 publications

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“…Our results show that when evaluating sensi- tivity and specificity of shunt images, one needs to relate to the exact shunt part in question: shunt tubing integrity, valve type and setting, and valve integrity. Regarding shunt tubing, the sensitivity of SXR in our series was relatively higher than previously stated (87%) [3][4][5][6][7][8][9][10]21], possibly because we evaluated only SXR and did not include the entire SS images. However, specificity of SXR was high (100%) [5,9,11,12].…”

Section: Discussioncontrasting

confidence: 67%

“…The aim of this study was not to justify SS, CT, or any other imaging. As stated above, the sensitivity of SS to diagnose the cause of shunt malfunction is <30%, and in most cases, a SS is not followed by any surgical revision [3][4][5][6][7][8][9][10]. Thus, SS and cranial imaging should be selectively performed.…”

Section: Discussionmentioning

confidence: 99%

“…Shunted patients presenting with symptoms of possible shunt malfunction often undergo various radiological evaluations, including shunt series (SS) and CT scans of their brains. The sensitivity of SS to diagnose the cause of shunt malfunction is <30%, and in most cases, a SS is not followed by any surgical revision [3][4][5][6][7][8][9][10]. However, the specificity of an abnormal SS is high, and thus they are commonly performed when shunt malfunction is suspected [5,9,11,12].…”

Section: Introductionmentioning

confidence: 99%

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The Role of 3D Reconstruction of the Skull in Patients with Suspected Shunt Malfunction

et al. 2021

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Background: Mechanical shunt malfunction may lead to significant morbidity and mortality. Shunt series assessments help evaluate shunt integrity; however, they are of limited value in the area of the skull due to skull curvature, thickness, and air sinuses. We describe the role of 3D bone reconstruction CT (3DCT) in demonstrating the shunt integrity over the skull, comparing this technique to skull X-rays (SXR). Methods: Data were collected retrospectively for shunted patients with concurrent SXR and 3DCT and for patients presenting with shunt failures at the region of the skull, including clinical course and radiological findings. We compared the SXR and 3DCT findings. The 3DCT was reconstructed from standard diagnostic CT protocols performed during evaluation of suspected shunt malfunction and not thin-slice CT protocols. Results: Forty-eight patients with 57 shunts underwent SXR and 3DCT. Interobserver agreement was high for most variables. Both SXR and 3DCT had a high sensitivity, specificity, and accuracy identifying tubing disconnections (between 0.83 and 1). Full valve type and setting were significantly more accurate based on SXR versus 3DCT (>90 vs. <20%), and valve integrity was significantly more readily verified on 3DCT versus SXR (100 vs. 52%). Conclusions: 3DCT and SXR complement each other in diagnosing mechanical shunt malfunctions over the skull. The main limitation of 3DCT is identification of valve type and settings, which are clearer on SXR, while the main limitation of SXR is a less ability to evaluate valve integrity. 3DCT also enables an intuitive 3D understanding of the shunt tubing over the skull.

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Section: Discussioncontrasting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Role of 3D Reconstruction of the Skull in Patients with Suspected Shunt Malfunction

et al. 2021

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“…12,31 This would be beneficial to the patients´ health even with the increased radiation dose. 24 The three highest scoring imaging techniques are C, B, and H, counting for a 65% of the total scores (table 3). The similarities amongst these images are the use of grid, which reduces the scattered radiation.…”

Section: Discussionmentioning

confidence: 99%

Optimization of Codman® Hakim® adjustable valve radiography

Bremnes

Kubosch

Ween

2017

RadOpen

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PurposeCerebrospinal fluid shunt valves are important tools in hydrocephalus treatment. Adjustable valves, sensitive to MRI, are onerous. They need be controlled; in case of re-settings. The vendor give advices for the radiographic procedure; however, hospitals use variations. The purpose was to investigate the different variations. MethodEight images consisting combinations of protocol features, were subjectively and anonymous rated for image quality. The panel consisted of 60 professionals; 50 radiographers and 10 radiologists, from two hospitals doing neurosurgery services. Signal-to-noise ratio compared the level of desired signal to the level of background noise.Results 348 scores were distributed onto all eight images, revealing the image quality difference was within acceptance. Options as valve on the head side near to the detector versus far to; differing geometry, use of head bowl versus not use, air-gap versus grids, were favored by both professional groups and at both hospitals in a clear priority image, given 2.5 times scores over average (108/43). Noise, revealed being the strongest indicator for priority of the best image for shunt evaluation.

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“…The SS comprises overlapping anteroposterior and lateral skull, chest and abdominal radiographs which may need to be repeated if suboptimal imaging is obtained due to patient movement. Desai et al 6 reported that SS has a poor sensitivity and a significant false-negative in the detection of SF and is even less likely to agree with the findings from other imaging modalities (CT, MRI, NMC) than by chance alone. Scout images obtained when planning head CT examinations may provide comparable images to lateral skull radiographs to evaluate the VP shunt catheter location.…”

Section: Commentarymentioning

confidence: 99%

Do children with suspected shunt failure also require a radiographic shunt series if head CT is going to be, or has been, performed?

et al. 2020

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The utility of the plain radiograph “shunt series” in the evaluation of suspected ventriculoperitoneal shunt failure in pediatric patients

Cited by 44 publications

References 12 publications

The Role of 3D Reconstruction of the Skull in Patients with Suspected Shunt Malfunction

The Role of 3D Reconstruction of the Skull in Patients with Suspected Shunt Malfunction

Optimization of Codman® Hakim® adjustable valve radiography

Do children with suspected shunt failure also require a radiographic shunt series if head CT is going to be, or has been, performed?

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