Hydrocephalus-related symptoms that worsen after shunt placement may indicate a malfunctioning
or obstructed shunt. The assessment of shunt patency and site of obstruction is important
for planning of treatment. The radionuclide cerebrospinal fluid (CSF) shunt study
provides a simple, effective, and low-radiation-dose method of assessing CSF shunt
patency. The radionuclide CSF shuntography is a useful tool in the management of patients
presenting with shunt-related problems not elucidated by conventional radiological
examination. This article described the imaging technique of ventriculoperitoneal
(VP) shunt and lumbar puncture (LP) shunt. The normal finding, abnormal finding of
completed obstruction and partial obstruction is present by our cases experience.
The radiopharmaceutical (Tc-99m diethylenetriaminepentaacetic acid) was injected via
the reservoir for VP shunt and via lumbar puncture needle in subarachnoid space for
LP shunt, then serial image in the head and abdominal area.
The normal function of VP and LP shunt usually rapid spillage of the radioactivity
in the abdominal cavity diffusely. The patent proximal tube VP shunt demonstrates
ventricular reflux. The early image of patent LP shunt reveals no activity in the
ventricular system contrast to distal LP shunt reveals early reflux of activity in
the ventricular system. The completed distal VP and LP shunt obstruction show absence
of tracer in the peritoneal area or markedly delayed appearance of abdominal activity.
The partial distal VP and LP shunt obstruction recognized by slow transit or accumulation
of tracer at the distal end or focal tracer in the peritoneal cavity near the tip
of distal shunt. The images of the normal and abnormal CSF shunt as describe before
are present in the full paper. Radionuclide CSF shuntography is a reliable and simple
procedure for assessment shunt patency.
Keywords
LP shunt - normal pressure hydrocephalus - radionuclide cerebrospinal fluid shuntography
- ventriculoperitoneal shunt
