Development and implementation of an ultralow-dose CT protocol for the assessment of cerebrospinal shunts in adult hydrocephalus

European Radiology Experimental

Aisling McMahon¹  Deirdre Hussey²  Michael G. J. O’Sullivan²  Niamh Moore³  Gerald Wyse⁴  Mika O’Callaghan Maher⁴  Noel Fanning⁴  Richard G. Kavanagh⁴  Stella Joyce⁴  David J. Ryan⁴  Michael M. Maher⁵  Owen J. O’Connor⁵ 

[1] Department of Medical Physics, Cork University Hospital, Wilton, T12 DC4A, Cork city, Ireland;Department of Neurosurgery, Cork University Hospital, Wilton, T12 DC4A, Cork city, Ireland;Department of Radiography, School of Medicine, Brookfield Health Sciences Complex, University College Cork, T12 AK54, Cork, Ireland;Department of Radiology, Cork University Hospital, Wilton, T12 DC4A, Cork city, Ireland;Department of Radiology, Cork University Hospital, Wilton, T12 DC4A, Cork city, Ireland;School of Medicine, University College Cork, Cork, Ireland;

关键词: Adult;    Cerebrospinal fluid shunts;    Hydrocephalus;    Radiation dosage;    Tomography (x-ray;    computed);   

DOI  :  10.1186/s41747-021-00222-4

来源: Springer

【 摘 要 】

BackgroundCerebrospinal fluid shunts in the treatment of hydrocephalus, although associated with clinical benefit, have a high failure rate with repeat computed tomography (CT) imaging resulting in a substantial cumulative radiation dose. Therefore, we sought to develop a whole-body ultralow-dose (ULD) CT protocol for the investigation of shunt malfunction and compare it with the reference standard, plain radiographic shunt series (PRSS).MethodsFollowing ethical approval, using an anthropomorphic phantom and a human cadaveric ventriculoperitoneal shunt model, a whole-body ULD-CT protocol incorporating two iterative reconstruction (IR) algorithms, pure IR and hybrid IR, including 60% filtered back projection and 40% IR was evaluated in 18 adult patients post new shunt implantation or where shunt malfunction was suspected. Effective dose (ED) and image quality were analysed.ResultsULD-CT permitted a 36% radiation dose reduction (median ED 0.16 mSv, range 0.07–0.17, versus 0.25 mSv (0.06–1.69 mSv) for PRSS (p = 0.002). Shunt visualisation in the thoracoabdominal cavities was improved with ULD-CT with pure IR (p = 0.004 and p = 0.031, respectively) and, in contrast to PRSS, permitted visualisation of the entire shunt course (p < 0.001), the distal shunt entry point and location of the shunt tip in all cases. For shunt complications, ULD-CT had a perfect specificity. False positives (3/22, 13.6%) were observed with PRSS.ConclusionsAt a significantly reduced radiation dose, whole body ULD-CT with pure IR demonstrated diagnostic superiority over PRSS in the evaluation of cerebrospinal fluid shunt malfunction.

【 授权许可】

CC BY