title: High-Resolution Three-Dimensional Computed Tomography for Assessing Complications Related to Intrathecal Drug Delivery.
abstract: The assessment of the functionality of intrathecal drug delivery (IDD) systems remains difficult and time-consuming. Catheter-related problems are still very common, and sometimes difficult to diagnose.
  
  
  
  The aim of the present study is to investigate the accuracy of high-resolution three-dimensional computed tomography (CT) in order to detect catheter-related pump dysfunction.
  
  
  
  An observational, retrospective investigation.
  
  
  
  Academic medical center in Germany.
  
  
  
  We used high-resolution three dimensional (3D) computed tomography with volume rendering technique (VRT) or fluoroscopy and conventional axial-CT to assess IDD-related complications in 51 patients from our institution who had IDD systems implanted for the treatment of chronic pain or spasticity.
  
  
  
  Twelve patients (23.5%) presented a total of 22 complications. The main type of complication in our series was catheter-related (50%), followed by pump failure, infection, and inappropriate refilling. Fluoroscopy and conventional CT were used in 12 cases. High-resolution 3D CT VRT scan was used in 35 instances with suspected yet unclear complications. Using 3D-CT (VRT) the sensitivity was 58.93% - 100% (CI 95%) and the specificity 87.54% - 100% (CI 95%).The positive predictive value was 58.93% - 100% (CI 95%) and the negative predictive value: 87.54% - 100% (CI 95%).Fluoroscopy and axial CT as a combined diagnostic tool had a sensitivity of 8.3% - 91.7% (CI 95%) and a specificity of 62.9% - 100% (CI 95%). The positive predictive value was 19.29% - 100% (CI 95%) and the negative predictive value: 44.43% - 96.89% (CI 95%).
  
  
  
  This study is limited by its observational design and the small number of cases.
  
  
  
  High-resolution 3D CT VRT is a non- invasive method that can identify IDD-related complications with more precision than axial CT and fluoroscopy.
authors.affiliation: University of Tuebingen, University Hospital, Dept. of Neurosurgery, Tuebingen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Morgalla
authors.affiliation: University of Tuebingen, University Hospital, Dept. of Neurosurgery, Tuebingen, Germany.
authors.forename: Marcos
authors.initials: M
authors.lastname: Fortunato
authors.affiliation: University of Tuebingen, University Hospital, Dept. of Neurosurgery, Tuebingen, Germany.
authors.forename: Ala
authors.initials: A
authors.lastname: Azam
authors.affiliation: University of Tuebingen, University Hospital, Dept. of Neurosurgery, Tuebingen, Germany.
authors.forename: Marcos
authors.initials: M
authors.lastname: Tatagiba
authors.affiliation: University of Tuebingen, University Hospital, Dept. of Neurosurgery, Tuebingen, Germany.
authors.forename: Guillherme
authors.initials: G
authors.lastname: Lepski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D057785:Catheters / Q000009:adverse effects*; D059350:Chronic Pain / Q000188:drug therapy; D005260:Female; D005858:Germany; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000592:standards*; D007260:Infusion Pumps / Q000009:adverse effects*; D060186:Infusions, Spinal / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009128:Muscle Spasticity / Q000188:drug therapy; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000592:standards*; D055815:Young Adult