Advertisement

Pediatric Radiology

, Volume 48, Issue 8, pp 1130–1138 | Cite as

Two signs indicative of successful access in nuclear medicine cerebrospinal fluid diversionary shunt studies

  • Mohammed S. Bermo
  • Hedieh Khalatbari
  • Marguerite T. Parisi
Original Article
  • 89 Downloads

Abstract

Background

Successful shunt access is the first step in a properly performed nuclear medicine cerebrospinal fluid (CSF) shunt study.

Objective

To determine the significance of the radiotracer configuration at the injection site during initial nuclear medicine CSF shunt imaging and the lack of early systemic radiotracer activity as predictors of successful shunt access.

Materials and methods

With Institutional Review Board approval, three nuclear medicine physicians performed a retrospective review of all consecutive CSF shunt studies performed in children at our institution in 2015. Antecedent nuclear medicine CSF shunt studies in these patients were also assessed and included in the review. The appearance of the reservoir site immediately after radiotracer injection was classified as either figure-of-eight or round/ovoid configuration. The presence or absence of early systemic distribution of the tracer on the 5-min static images was noted and separately evaluated.

Results

A total of 98 nuclear medicine ventriculoperitoneal CSF shunt studies were evaluated. Figure-of-eight configuration was identified in 87% of studies and, when present, had 93% sensitivity, 78% specificity, 92% accuracy, 98% positive predictive value (PPV) and 54% negative predictive value (NPV) as a predictor of successful shunt access. Early systemic activity was absent in 89 of 98 studies. Lack of early systemic distribution of the radiotracer had 98% sensitivity, 78% specificity, 96% accuracy, 98% PPV and 78% NPV as a predictor of successful shunt access. Figure-of-eight configuration in conjunction with the absence of early systemic tracer activity had 99% PPV for successful shunt access.

Conclusion

Figure-of-eight configuration at the injection site or lack of early systemic radiotracer activity had moderate specificity for successful shunt access. Specificity and PPV significantly improved when both signs were combined in assessment.

Keywords

Cerebrospinal fluid Children Radionuclide scintigraphy Rickham reservoir Ventriculoperitoneal shunts 

Notes

Compliance with ethical standards

Conflicts of interest

None

References

  1. 1.
    Hegde A, Nair RP, Ganapathy S et al (2016) Shunt malfunction in patients with hydrocephalus: complications revisited. BMJ Case Rep 2016.  https://doi.org/10.1136/bcr-2015-213619
  2. 2.
    Riva-Cambrin J, Kestle JR, Holubkov R et al (2016) Risk factors for shunt malfunction in pediatric hydrocephalus: a multicenter prospective cohort study. J Neurosurg Pediatr 17:382–390CrossRefPubMedGoogle Scholar
  3. 3.
    Boyle TP, Nigrovic LE (2015) Radiographic evaluation of pediatric cerebrospinal fluid shunt malfunction in the emergency setting. Pediatr Emerg Care 31:435–440CrossRefPubMedGoogle Scholar
  4. 4.
    Maller VV, Agarwal A, Kanekar S (2016) Imaging of ventricular shunts. Semin Ultrasound CT MR 37:159–173CrossRefPubMedGoogle Scholar
  5. 5.
    Wallace AN, McConathy J, Menias CO et al (2014) Imaging evaluation of CSF shunts. AJR Am J Roentgenol 202:38–53CrossRefPubMedGoogle Scholar
  6. 6.
    Sivaganesan A, Krishnamurthy R, Sahni D et al (2012) Neuroimaging of ventriculoperitoneal shunt complications in children. Pediatr Radiol 42:1029–1046CrossRefPubMedGoogle Scholar
  7. 7.
    May CH, Aurisch R, Kornrumpf D et al (1999) Evaluation of shunt function in hydrocephalic patients with the radionuclide 99mTc-pertechnetate. Childs Nerv Syst 15:239–244CrossRefPubMedGoogle Scholar
  8. 8.
    Vassilyadi M, Tataryn ZL, Matzinger MA et al (2006) Radioisotope shuntograms at the Children's Hospital of Eastern Ontario. Childs Nerv Syst 22:43–49CrossRefPubMedGoogle Scholar
  9. 9.
    Thompson EM, Wagner K, Kronfeld K et al (2014) Using a 2-variable method in radionuclide shuntography to predict shunt patency. J Neurosurg 121:1504–1507CrossRefPubMedGoogle Scholar
  10. 10.
    Treves ST, SpringerLink (Online service) (2007) Pediatric Nuclear Medicine/PET. Springer Science+Business Media, LLC, New York, NYCrossRefGoogle Scholar
  11. 11.
    Vernet O, Farmer JP, Lambert R et al (1996) Radionuclide shuntogram: adjunct to manage hydrocephalic patients. J Nucl Med 37:406–410PubMedGoogle Scholar
  12. 12.
    Key CB, Rothrock SG, Falk JL (1995) Cerebrospinal fluid shunt complications: an emergency medicine perspective. Pediatr Emerg Care 11:265–273CrossRefPubMedGoogle Scholar
  13. 13.
    Rocque BG, Lapsiwala S, Iskandar BJ (2008) Ventricular shunt tap as a predictor of proximal shunt malfunction in children: a prospective study. J Neurosurg Pediatr 1:439–443CrossRefPubMedGoogle Scholar
  14. 14.
    Vega RA, Buscher MG, Gonzalez MS et al (2013) Sonographic localization of a nonpalpable shunt: Ultrasound-assisted ventricular shunt tap. Surg Neurol Int 4:101CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Rickham PP (1964) A ventriculostomy reservoir. Br Med J 2:173CrossRefPubMedGoogle Scholar
  16. 16.
    Scott RM (1991) Shunt malfunction and the Rickham reservoir. Neurosurgery 28:167CrossRefPubMedGoogle Scholar
  17. 17.
    Weiser HC, Gilbert JW (1990) Needle size for puncture of a Rickham reservoir. Surg Neurol 33:230CrossRefPubMedGoogle Scholar
  18. 18.
    Schlosser HG, Crawack HJ, Miethke C et al (2016) An improved reservoir for the flushing test to diagnose shunt insufficiency. Neurosurg Focus 41:E14CrossRefPubMedGoogle Scholar
  19. 19.
    MacDonald A, Burrell S (2009) Infrequently performed studies in nuclear medicine: part 2. J Nucl Med Technol 37:1–13CrossRefPubMedGoogle Scholar
  20. 20.
    Lehnert BE, Rahbar H, Relyea-Chew A et al (2011) Detection of ventricular shunt malfunction in the ED: relative utility of radiography, CT, and nuclear imaging. Emerg Radiol 18:299–305CrossRefPubMedGoogle Scholar
  21. 21.
    O'Brien DF, Taylor M, Park TS et al (2003) A critical analysis of 'normal' radionucleotide shuntograms in patients subsequently requiring surgery. Childs Nerv Syst 19:337–341CrossRefPubMedGoogle Scholar
  22. 22.
    Ouellette D, Lynch T, Bruder E et al (2009) Additive value of nuclear medicine shuntograms to computed tomography for suspected cerebrospinal fluid shunt obstruction in the pediatric emergency department. Pediatr Emerg Care 25:827–830CrossRefPubMedGoogle Scholar
  23. 23.
    Chiewvit S, Nuntaaree S, Kanchaanapiboon P, Chiewvit P (2014) Assessment lumboperitoneal or ventriculoperitoneal shunt patency by radionuclide technique: a review experience cases. World J Nucl Med 13:75–84CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Chervu S, Chervu LR, Vallabhajosyula B et al (1984) Quantitative evaluation of cerebrospinal fluid shunt flow. J Nucl Med 25:91–95PubMedGoogle Scholar
  25. 25.
    Wynchank S, Brendel AJ, Castel JP et al (1984) Re: Quantitative evaluation of cerebrospinal fluid shunt flow. J Nucl Med 25:1269–1270PubMedGoogle Scholar
  26. 26.
    Brendel AJ, Wynchank S, Castel JP et al (1983) Cerebrospinal shunt flow in adults: radionuclide quantitation with emphasis on patient position. Radiology 149:815–818CrossRefPubMedGoogle Scholar
  27. 27.
    Lawrance SK (2003) Cerebrospinal fluid imaging. In: Sandler MP (ed) Diagnostic nuclear medicine, 4th edn. Lippincott Williams & Wilkins, Philadelphia, PAGoogle Scholar
  28. 28.
    Di Rocco C, Turgut M, Jallo GI Martinez-Lage J (2015) Complications of CSF shunting in hydrocephalus prevention, identification, and management. Springer, HeidelbergGoogle Scholar
  29. 29.
    Gok B, Batra S, Eslamy H et al (2013) Radionuclide shunt patency study for suspected ventriculoatrial shunt malfunction. Clin Nucl Med 38:527–533CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of RadiologyUniversity of WashingtonSeattleUSA
  2. 2.Department of RadiologySeattle Children’s HospitalSeattleUSA
  3. 3.Department of Pediatrics, Seattle Children’s HospitalUniversity of Washington School of MedicineSeattleUSA

Personalised recommendations