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Assessment lumboperitoneal or ventriculoperitoneal shunt patency by radionuclide technique: a review experience cases.

Chiewvit S, Nuntaaree S, Kanchaanapiboon P, Chiewvit P - World J Nucl Med (2014)

Bottom Line: The radionuclide CSF shuntography is a useful tool in the management of patients presenting with shunt-related problems not elucidated by conventional radiological examination.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Division of Nuclear Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.

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.

No MeSH data available.


Related in: MedlinePlus

(a) ventricular dilatation of lateral ventricle out of proportion to CSF spaces over hemispheres convexity. b) Evan's index = 0.4
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Figure 1: (a) ventricular dilatation of lateral ventricle out of proportion to CSF spaces over hemispheres convexity. b) Evan's index = 0.4

Mentions: The radionuclide CSF shunt study provides a simple, effective, and low-radiation-dose method of assessing CSF shunt patency. However, this method is not frequently requested and currently, no consensus guidelines or recommended approach to diagnostic imaging exists in the evaluation of CSF shunt obstruction. The reasons are due to initial assessment of the patient with a CSF shunt presenting with symptoms is performed clinically. The clinician cans simple assess the shunt system by pump test. The clinician may also access the shunt reservoir to measure opening pressure and obtain CSF for culture and laboratory analysis. Computed tomography (CT) is often performed initially to assess ventricular size in which dilatation of lateral ventricles [Figure 1a and b] is demonstrated and increase of ratio between frontal horns width to biparietal diameter width as Evan's ratio. Changing of configuration of frontal horns, temporal horn and 3rd ventricle are encountered by CT scan [Figures 2 and 3] and sign of increase intraventricular pressure such as transependymal edema as transmits of CSF into brain parenchyma [Figure 4]. However, this technique is not entirely reliable, however, as patients may have chronically enlarged ventricles. CT is most reliable in this setting if there are prior scans to allow determination of whether the ventricles have increased in size. The CT may also be used to verify the correct placement of a CSF shunt.


Assessment lumboperitoneal or ventriculoperitoneal shunt patency by radionuclide technique: a review experience cases.

Chiewvit S, Nuntaaree S, Kanchaanapiboon P, Chiewvit P - World J Nucl Med (2014)

(a) ventricular dilatation of lateral ventricle out of proportion to CSF spaces over hemispheres convexity. b) Evan's index = 0.4
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4150163&req=5

Figure 1: (a) ventricular dilatation of lateral ventricle out of proportion to CSF spaces over hemispheres convexity. b) Evan's index = 0.4
Mentions: The radionuclide CSF shunt study provides a simple, effective, and low-radiation-dose method of assessing CSF shunt patency. However, this method is not frequently requested and currently, no consensus guidelines or recommended approach to diagnostic imaging exists in the evaluation of CSF shunt obstruction. The reasons are due to initial assessment of the patient with a CSF shunt presenting with symptoms is performed clinically. The clinician cans simple assess the shunt system by pump test. The clinician may also access the shunt reservoir to measure opening pressure and obtain CSF for culture and laboratory analysis. Computed tomography (CT) is often performed initially to assess ventricular size in which dilatation of lateral ventricles [Figure 1a and b] is demonstrated and increase of ratio between frontal horns width to biparietal diameter width as Evan's ratio. Changing of configuration of frontal horns, temporal horn and 3rd ventricle are encountered by CT scan [Figures 2 and 3] and sign of increase intraventricular pressure such as transependymal edema as transmits of CSF into brain parenchyma [Figure 4]. However, this technique is not entirely reliable, however, as patients may have chronically enlarged ventricles. CT is most reliable in this setting if there are prior scans to allow determination of whether the ventricles have increased in size. The CT may also be used to verify the correct placement of a CSF shunt.

Bottom Line: The radionuclide CSF shuntography is a useful tool in the management of patients presenting with shunt-related problems not elucidated by conventional radiological examination.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Division of Nuclear Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand.

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.

No MeSH data available.


Related in: MedlinePlus