Ultrasound for the assessment of distal shunt malfunction in adults with internal ventricular shunts

• Published in: Journal of clinical neuroscience Vol. 45; pp. 282 - 287
• Main Authors: Moran, S. Dane, Theodros, Debebe, Jusué-Torres, Ignacio, Holman, E. Marianna, DeJong, M. Robert, Lu, Jennifer, Hoffberger, Jamie, Rigamonti, Daniele
• Format: Journal Article
• Language: English
• Published: Scotland Elsevier Ltd 01-11-2017
• Subjects: Female; Humans; Hydrocephalus; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Radionuclide Imaging; ROC Curve; Sensitivity and Specificity; Ultrasonography; Ventriculoperitoneal shunt; Ventriculoperitoneal Shunt - adverse effects; Sensitivity and specificity; Hydrocephalus; Ventriculoperitoneal shunt; Ultrasonography; Radionuclide imaging
• ISSN: 0967-5868; 1532-2653
• DOI: 10.1016/j.jocn.2017.08.026

•Ultrasound can be used to assess shunt patency.•The performance of the ultrasound test is comparable to the radionuclide shunt patency test.•Advantages of using ultrasound include that it is: affordable, safe, and quick and easy to do.
Shunts that are used for the treatment of hydrocephalus have a propensity towards malfunction, however, diagnosing a shunt malfunction can sometimes be a challenge. The purpose of this study was to investigate whether ultrasound technology can be safely and effectively used to assess for distal shunt malfunction. This was a prospective cohort study at a single institution. Eighteen adult patients that received a radionuclide shunt patency study also underwent an ultrasound shunt patency study. Ultrasound with Doppler technology was used to visualize flow through the shunt tubing following manual compression of the shunt reservoir. A peak flow speed was recorded and the results were compared to the results of the radionuclide shunt patency study. A Receiver Operating Characteristic (ROC) curve comparing the ultrasound to the radionuclide shunt patency study was generated, revealing an Area Under the Curve (AUC) of 0.95 (95% CI: 0.84–1.00). The ultrasound test performed maximally with a cutoff speed of ≤10cm/s as the criteria for malfunction, with a sensitivity of 100.00%, specificity of 90.91%, accuracy of 94.44%, positive likelihood ratio of 11.000 and negative likelihood ratio of 0.000 using the radionuclide study results as criteria for comparison. Overall, ultrasound has the potential to be a safe, quick, available and cost-effective screening test for patients with suspected distal shunt malfunction. The high sensitivity of the test makes it an attractive option for use as a screening method that could potentially reduce the number of cases requiring radionuclide shunt patency study.