title: Imaging of Ventriculoperitoneal Shunt Complications: Comparison of Whole Body Low-Dose Computed Tomography and Radiographic Shunt Series.
abstract: OBJECTIVE
  To determine diagnostic value and radiation exposure of low-dose computed tomography (LD-CT) compared to radiographic shunt series (SS) for the detection of ventriculoperitoneal (VP) shunt complications.
  
  
  METHODS
  Fourteen VP shunts were implanted in 7 swine cadavers. Mechanical complications were induced in 50% of VP shunts. Low-dose CT (80 kVp, 10 mAs, Pitch = 1.5) and SS were acquired. Dose area product (DAP) and effective doses for SS and LD-CT were collected. Scoring of diagnostic confidence and blinded readings of SS and CT data were performed.
  
  
  RESULTS
  The sensitivity of LD-CT was high (0.97; 95% confidence interval, 0.91-1.00) with excellent interobserver agreement (κ = 0.88). Similarly, the sensitivity of SS was high (0.82; 95% confidence interval, 0.68-0.95) with good interobserver agreement (κ = 0.68). In contrast, LD-CT was associated with significantly higher diagnostic confidence (4.64 ± 0.41 vs 2.71 ± 0.73; P < 0.01) and significantly lower radiation exposure (effective dose: 0.26 mSv vs 1.06 mSv; DAP: 265.4 μGym vs 724.8 μGym; P < 0.001).
  
  
  CONCLUSIONS
  For the assessment of suspected VP shunt complications, LD-CT provides excellent sensitivity and higher diagnostic confidence with lower radiation exposure compared with SS.
authors.affiliation: From the *Department of Diagnostic and Interventional Neuroradiology, †Department of Neurosurgery, Uniklinik RWTH Aachen, Aachen; ‡Department of Radiation Protection, §Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, Tübingen; ∥Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz; and ¶Institute of Neuroscience and Medicine 4, Forschungszentrum Jülich GmbH, Jülich, Germany.
authors.forename: Saif
authors.initials: S
authors.lastname: Afat
authors.forename: Rastislav
authors.initials: R
authors.lastname: Pjontek
authors.forename: Hussam A
authors.initials: HA
authors.lastname: Hamou
authors.forename: Klaus
authors.initials: K
authors.lastname: Herz
authors.forename: Omid
authors.initials: O
authors.lastname: Nikoubashman
authors.forename: Fabian
authors.initials: F
authors.lastname: Bamberg
authors.forename: Marc A
authors.initials: MA
authors.lastname: Brockmann
authors.forename: Konstantin
authors.initials: K
authors.lastname: Nikolaou
authors.forename: Hans
authors.initials: H
authors.lastname: Clusmann
authors.forename: Martin
authors.initials: M
authors.lastname: Wiesmann
authors.forename: Ahmed E
authors.initials: AE
authors.lastname: Othman
mesh_terms: D000818:Animals; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000209:etiology; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000032:analysis* / Q000517:prevention & control; D011835:Radiation Protection / Q000379:methods*; D011856:Radiographic Image Enhancement / Q000379:methods; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D013552:Swine; D014057:Tomography, X-Ray Computed / Q000379:methods*; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*; D051598:Whole Body Imaging / Q000379:methods*