RT Journal Article
SR Electronic
T1 Diagnostic Performance of Whole-Body Ultra-Low-Dose CT for Detection of Mechanical Ventriculoperitoneal Shunt Complications: A Retrospective Analysis
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP 1597
OP 1602
DO 10.3174/ajnr.A7672
VO 43
IS 11
A1 S. Afat
A1 R. Pjontek
A1 O. Nikoubashman
A1 W.G. Kunz
A1 M.A. Brockmann
A1 H. Ridwan
A1 M. Wiesmann
A1 H. Clusmann
A1 A.E. Othman
A1 H.A. Hamou
YR 2022
UL http://www.ajnr.org/content/43/11/1597.abstract
AB BACKGROUND AND PURPOSE: Radiographic shunt series are still the imaging technique of choice for radiologic evaluation of VP-shunt complications. Radiographic shunt series are associated with high radiation exposure and have a low diagnostic performance. Our aim was to investigate the diagnostic performance of whole-body ultra-low-dose CT for detecting mechanical ventriculoperitoneal shunt complications.MATERIALS AND METHODS: This retrospective study included 186 patients (mean age, 54.8 years) who underwent whole-body ultra-low-dose CT (100 kV[peak]; reference, 10 mAs). Two radiologists reviewed the images for the presence of ventriculoperitoneal shunt complications, image quality, and diagnostic confidence. On a 5-point Likert scale, readers scored image quality and diagnostic confidence (1 = very low, 5 = very high). Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Radiation dose estimation of whole-body ultra-low-dose CT was calculated and compared with the radiation dose of a radiographic shunt series.RESULTS: 34 patients positive for VP-shunt complications were correctly identified on whole-body ultra-low-dose CT by both readers. No false-positive or -negative cases were recorded by any of the readers, yielding a sensitivity of 100% (95% CI, 87.3%–100%), a specificity of 100% (95% CI, 96.9%–100%), and perfect agreement (κ = 1). Positive and negative predictive values were high at 100%. Shunt-specific image quality and diagnostic confidence were very high (median score, 5; range, 5–5). Interobserver agreement was substantial for image quality (κ = 0.73) and diagnostic confidence (κ = 0.78). The mean radiation dose of whole-body ultra-low-dose CT was significantly lower than the radiation dose of a conventional radiographic shunt series (0.67 [SD, 0.4] mSv versus 1.57 [SD, 0.6] mSv; 95% CI, 0.79–1.0 mSv; P < .001).CONCLUSIONS: Whole-body ultra-low-dose CT allows detection of ventriculoperitoneal shunt complications with excellent diagnostic accuracy and diagnostic confidence. With concomitant radiation dose reduction on contemporary CT scanners, whole-body ultra-low-dose CT should be considered an alternative to the radiographic shunt series.IQRinterquartile rangeVP-shuntventriculoperitoneal shuntWB-ULD-CTwhole-body ultra-low-dose CT