Placement of Ventriculoperitoneal (VP)-shunt is a standard procedure for the treatment of hydrocephalus for various conditions like normal pressure hydrocephalus (NPH), intracranial hemorrhage, aneurysmal subarachnoid hemorrhage, meningitis, tumor, or trauma. Despite being widely used, the rate of shunt failure after 1 year has been reported to be between 20% to 40% of VP-shunts requiring revision within 6 years of placement (1,2). These VP-shunts require often revision surgeries that can affect quality of life. In case of suspected VP shunt malfunction, a computed tomography (CT) head...

This retrospective study included 100 patients (mean age: 56.1 ± 18.8 years, 51 female) with suspected VP-Shunt complication who underwent whole Body LD-CT (tube voltage, 100 kVp; tube current-time product, 10 mAs). The CT images were independently reviewed by three radiologists for presence/absence of mechanical VP-shunt complications, overall image quality and diagnostic confidence. On a five-point Likert scale the readers scored the IQ (1= very low, 5 very high) and the DC (1= low confidence, 5= high confidence). ROC analysis and the area under the...

Image quality was rated very good (median score, 5; range, 4-5). Diagnostic confidence was rated very high (median score, 5; range, 4-5). Interobserver agreement was almost perfect for IQ (κ = 0.810) and for DC (κ = 0.808). Twenty-two out of the 100 included patients had confirmed mechanical VP-Shunt complications. Twenty-one positive patients were correctly identified on LD-CT by all 3 readers, no false positive cases were recorded by any of the readers, yielding a sensitivity of 95.5 %, a specificity of 100% (95% CI,...

Whole-body LD-CT allows detection of VP-Shunt complication with excellent diagnostic accuracy and very high diagnostic confidence. Our results indicate that LD-CT is an accurate diagnostic tool for the detection of VP-shunt complications and have the potential to replace the gold standard (plain radiographic shunt series) in clinical routine.

1. Al-Tamimi YZ, Sinha P, Chumas PD et al. (2014) Ventriculoperitoneal shunt 30-day failure rate: a retrospective international cohort study. Neurosurgery. 2. Farahmand D, Hilmarsson H, Hogfeldt M, et al. (2009) Perioperative risk factors for short term shunt revisions in adult hydrocephalus patients. J Neurol Neurosurg Psychiatry. 3. Othman A, Hamou HA, Pjontek R, et al. (2015) Evaluation of whole body ultralow-dose CT for the assessment of ventriculoperitoneal shunt complications: an experimental ex-vivo study in a swine model. Eur Radiol. 4.Afat S, Pjontek R, Hamou...