Article
Optimising the evaluation of shunt malfunction with 3D venous phase contrast angiography MRI
Venöse 3D-Phasenkontrastangiographie als valides Tool in der Diagnostik von Shuntdysfunktionen
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Authors
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Monika Huhndorf
- Universitätsklinikum Schleswig-Holstein, Neuroradiologie, Kiel, Deutschland
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Gesa Cohrs
- Universitätsklinikum Schleswig-Holstein, Klinik für Neurochirurgie, Kiel, Deutschland
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Nils Margraf
- Universitätsklinikum Schleswig-Holstein, Neurologie, Kiel, Deutschland
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Michael Synowitz
- Universitätsklinikum Schleswig-Holstein, Klinik für Neurochirurgie, Kiel, Deutschland
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Olav Jansen
- Universitätsklinikum Schleswig-Holstein, Neuroradiologie, Kiel, Deutschland
| Published: | June 26, 2020 |
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Outline
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Objective: In the situation of suspected shunt malfunction MRI is widely accepted as a primary evaluation tool, especially in paediatric patients. Clinical symptoms can be unspecific, and the presence or absence of ventricular enlargement does not reliably predict raised intracranial pressure (ICP) in these patients. Therefore, we aimed to investigate the utility of 3D venous phase contrast angiography (PCA) in the situation of shunt failure and suspected raised intracranial pressure.
Methods: We retrospectively analysed MRI studies of shunted children presenting with symptoms of elevated ICP and therefore receiving surgery due to shunt malfunction. Patients were included when pre- and postoperative MRI was performed including an axial T2-weighted image and 3D venous PCA. We assessed Evans’ index on T2 weighted images for assessment of ventricular enlargement and evaluated venous PCA for signs of compression of the sagittal superior sinus and the left and right transverse sinus. Sinus compression was defined as reduction in diameter and/or reduced/missing signal. Elevated intracranial pressure was defined as compression of at least two sinuses.
Results: We included 19 (11 male) shunted patients who had clinical symptoms of raised intracranial pressure and received surgery for shunt dysfunction, on whom pre- and postoperative MRI was performed. All three sinuses were compressed in 12 patients, of which 11 showed normalization after shunt revision. Only two sinuses were compressed in 6 children. 3D venous PCA showed normalization after shunt revision in all cases. Of18 patients with compression of 2 or 3 sinuses 15 showed no significant change in Evans’ Index. The only patient who did not show any sinus compression showed significant change in Evans’ Index.
Conclusion: In accordance with the current literature our results confirmthat ventricular morphology alone is not a reliable marker for elevated ICP in shunt malfunction.Our resultsshow that sinus compression might serve as a predictorfor elevated ICP. In order to confirm indication for revision surgery, the addition of 3D venous PCA is a helpful tool. This could especially be useful to identify paediatric patients with elevated ICP in which assessment of clinical symptoms can be challenging.
