Contrast-enhanced shunt series ("shuntography") compare favorably to other shunt imaging modalities in detecting shunt occlusion.
Obstruction is a common cause of ventriculo-peritoneal shunt failure. Head computed tomography and plain x-ray examinations of shunt tubing ("shunt series") are routinely used in patients readmitted for reemerging symptoms but are of limited value. The validity of shunt series can be improved by applying contrast agent into the system (contrast-enhanced shunt series, a.k.a. a "shuntogram" or "shuntography"). We hypothesized that contrast-enhanced shunt series have a high predictive value for shunt revision surgeries.



We retrospectively re-evaluated 107 contrast-enhanced shunt series and reviewed the patient histories. We defined outcome parameters for calculating the utility of a pathological contrast-enhanced shunt series in predicting revision surgery.



Of 107 contrast-enhanced shunt series, 41 examinations were positive for obstruction, mainly of the ventricular (36.5 %) and the peritoneal catheter (48.8 %). Within 30 days, 35 successful revision surgeries and 3 revision surgeries without resolution of symptoms were performed. In two cases the shunt tubing was found to be patent. Sixty-six negative examinations resulted in two revision surgeries, in addition to ten surgeries not attempting to restore patency. After 30 days, the specificity of contrast-enhanced shunt series for shunt failure identification was calculated at 92.8 %, the sensitivity at 94.7 %, the positive predictive value at 87.8 %, and the negative predictive value at 97.0 %.



The contrast-enhanced shunt series method is a highly specific examination with a negative predictive value exceeding that of head computed tomography and plain shunt series. Compared to radionuclide marker studies, contrast-enhanced shunt series demonstrate better spatiotemporal resolution, enabling focused local surgical repair.
Departments of Neurosurgery, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37070, Göttingen, Germany. kajetan.voneckardstein@med.uni-goettingen.de.
Kajetan L
KL
von Eckardstein
Departments of Neuroradiology, Universitätsmedizin Göttingen, Göttingen, Germany.
Kai
K
Kallenberg
Departments of Neuroradiology, Universitätsmedizin Göttingen, Göttingen, Germany.
Marios-Nikos
MN
Psychogios
Departments of Neurosurgery, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37070, Göttingen, Germany.
Bawarjan
B
Schatlo
Departments of Neurosurgery, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37070, Göttingen, Germany.
Veit
V
Rohde
Departments of Neurosurgery, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37070, Göttingen, Germany.
Hans Christoph
HC
Ludwig
Departments of Neurosurgery, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37070, Göttingen, Germany.
Hans Christoph
HC
Bock
D000328:Adult; D004868:Equipment Failure / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011856:Radiographic Image Enhancement / Q000379:methods* / Q000592:standards; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000592:standards; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects / Q000706:statistics & numerical data*
CSF diversion procedure; Complication management; Hydrocephalus; Shunt evaluation; Ventriculoperitoneal shunt