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Detection of ventricular shunt malfunction in the ED: relative utility of radiography, CT, and nuclear imaging

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Abstract

The study objective was to determine the relative diagnostic utility of the radiographic shunt series (SS), head computed tomography (CT), and nuclear imaging performed in our Emergency Department (ED) for evaluating ventricular shunt malfunction. We retrospectively reviewed medical records, head CT (if performed), and nuclear imaging (if performed) for all ED patients with suspected shunt malfunction from 2002 to 2007 who underwent plain film shunt evaluation (296 cases/186 individuals) to determine if surgical shunt revision was performed. Logistic regression analysis was applied. Four percent (12/296) of radiographic SS were abnormal. Only 0.3% (1/296) underwent surgical revision in the absence of an abnormal head CT or nuclear imaging. Eighteen percent (51/282) of head CT exams were positive and 19% (24/128) of nuclear imaging exams were positive for shunt malfunction. Twenty-three percent (67/296) underwent surgical shunt revisions. Statistical analysis demonstrated that SS evaluation was not significantly associated with surgical shunt revision (OR 0.92; 95% CI, 0.7–1.2; p = 0.47). Head CT demonstrated a significant association with surgical revision (OR 1.4; 95% CI, 1.2–1.5; p < 0.001), as did nuclear imaging (OR 1.4; 95% CI, 1.2–1.6; p < 0.001). Patients with suspected ventricular shunt malfunction frequently require surgical revision. Abnormal radiographic SS was not associated with progression to surgical shunt revision, whereas abnormal head CT and abnormal nuclear imaging were significantly associated with surgical revision. We conclude that radiographic SS in the ED is of low diagnostic utility and that patients with suspected shunt malfunction should instead initially undergo CT and/or nuclear imaging.

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Authors and Affiliations

  1. Department of Radiology, University of Washington, 1959 Pacific Street, Room RR215, Box 357115, Seattle, WA, 98195–7117, USA

    Bruce E. Lehnert, Habib Rahbar, Michael L. Richardson & James R. Fink

  2. Department of Radiology, Harborview Medical Center, 325-9th Avenue, Room 1CT-119, Box 359728, Seattle, WA, 98104–2499, USA

    Annemarie Relyea-Chew & David H. Lewis

  3. UWMC Roosevelt Radiology Clinic, 4245 Roosevelt Way NE, 2nd floor, Box 354755, Seattle, WA, 9810, USA

    Michael L. Richardson

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  1. Bruce E. Lehnert
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  2. Habib Rahbar
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  3. Annemarie Relyea-Chew
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  4. David H. Lewis
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  5. Michael L. Richardson
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  6. James R. Fink
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Correspondence to Bruce E. Lehnert.

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Lehnert, B.E., Rahbar, H., Relyea-Chew, A. et al. Detection of ventricular shunt malfunction in the ED: relative utility of radiography, CT, and nuclear imaging. Emerg Radiol 18, 299–305 (2011). https://doi.org/10.1007/s10140-011-0955-6

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  • DOI: https://doi.org/10.1007/s10140-011-0955-6

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