Article
Assessability of ventricular width and intraventricular CSF shunt catheter position with ultra-low-dose CT
Beurteilbarkeit der Ventrikelweite und der intraventrikulären Lage von Cerebralshunt-Kathetern mit Ultra-low-dose CT
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Authors
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Rastislav Pjontek
- Universitätsklinikum Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
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Hülya Pinar Hasirci
- Universitätsklinikum Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
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Hani Ridwan
- Universitätsklinikum Aachen, Department of Diagnostic and Interventional Neuroradiology, Aachen, Deutschland
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Mohammed Alzaiyani
- Universitätsklinikum Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
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Anke Höllig
- Universitätsklinikum Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
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Hans Clusmann
- Universitätsklinikum Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
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Hussam Aldin Hamou
- Universitätsklinikum Aachen, Klinik für Neurochirurgie, Aachen, Deutschland
| Published: | June 4, 2021 |
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Outline
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Objective: Whole body ultra-low-dose CT (ULD-CT) has replaced the radiographic shunt series as standard imaging method for ventriculoperitoneal or ventriculoatrial shunt at our institution. ULD-CT allows more precise assessment of distal shunt catheter with more confident depiction of potential complications such as disconnection, pseudocyst formation or extraperitoneal dislocation. However, full-dose cranial CT (cCT) remains the gold standard for the intracranial assessment of CSF-shunt. Patients with implanted CSF-shunt often require multiple cCT-scans in the course resulting in high radiation exposition. We retrospectively analyzed the feasibility of UDL-CT for evaluation of interventricular position of shunt-catheter as well as ventricular width.
Methods: Out of 358 ULD-CTs (100kV, 10mAs, care dose) of CSF-shunts performed at our institution between 2016 and 2019 267 ULD-CTs from 161 patients included the skull. Three blinded independent readers evaluated the assessability of the intraventricular catheter position using a Likert-type scale of 1-4 and measured the ventricular width on the level of anterior horns of lateral ventricles. The ventricular width quantificated in 67 ULD-CT was compared with full dose cCT done immediately before or after ULD-CT.
Results: An extraventricular position of the CSF-shunt as a complication was present in two individuals and correctly depicted by all readers. One intraventricular catheter was incorrect described as extraventricular. There were no missed dislocations. The assessabilty of the intraventricular position was rated “very good” or “good” in 246 (92%) and “limited” or “poor” in 21 (8%) examinations with a substantial inter-rater agreement (kappa: 0,61).
In comparison with full dose cCTs as gold standard mean deviation of the ventricular width was 2,13mm (5,42%; range 0-10,7mm).
The mean CTDI of ULD-CTs was 0,66 mGy and the mean DLP for the whole body 49,13 mGy*cm reaching 1,05% and 5,9% of the cCT radiation dose (mean CDTI: 62,62 mGy; mean DLP: 827,98 mGy*cm), respectively.
Conclusion: Intraventricular position of proximal CSF-shunt catheter can be evaluated by ULD-CT in the majority of cases. The assessability is limited e.g. in patients with slit ventricles, artifacts or hypodense defects. Moreover, UDT-CT allows accurate evaluation of the ventricular width. Further studies are needed to find the optimal (ultra) low-dose protocol for assessment of ventricular width (in patients with CSF shunt).
