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Venous 3D Phase Contrast Magnetic Resonance Angiography Increases Diagnostic Certainty in Children with

M Huhndorf1, S Peters2, J Cordt2

  • 1Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany. monika.huhndorf@uksh.de.

Clinical Neuroradiology
|July 3, 2023
PubMed

Insights

3D venous phase-contrast MR angiography (vPCA) improves diagnosis of shunt malfunction in children. This technique enhances accuracy in detecting elevated intracranial pressure (ICP) when ventricular size is unchanged.

Area of Science:

  • Neurology
  • Medical Imaging
  • Pediatric Neurosurgery

Background:

  • Clinical symptoms of pediatric shunt malfunction are often non-specific.
  • Ventricular enlargement on MRI does not reliably indicate elevated intracranial pressure (ICP).

Purpose of the Study:

  • To investigate the diagnostic utility of 3D venous phase-contrast MR angiography (vPCA) for shunt malfunction.
  • To assess if 3D vPCA improves the detection of elevated ICP in children with ventriculoperitoneal shunts.

Main Methods:

  • Retrospective analysis of MRI studies from two patient groups (symptomatic and asymptomatic).
  • Inclusion of axial T2-weighted images and 3D vPCA in all MRI examinations.
  • Evaluation of images by two neuroradiologists for suspected elevated ICP, assessing interrater reliability, sensitivity, and specificity.

Main Results:

  • Venous sinus compression was significantly more frequent in patients with shunt failure (p=0.00003).
  • Combined 3D vPCA and T2-weighted imaging increased sensitivity to 0.92-1.0, compared to 0.69-0.77 for T2-weighted images alone.
  • Interrater agreement for shunt failure diagnosis improved from κ=0.71 to κ=0.837 with the addition of 3D vPCA.

Conclusions:

  • Ventricular morphology alone is an unreliable indicator of elevated ICP in pediatric shunt malfunction.
  • 3D vPCA is a valuable supplemental tool for diagnosing shunt failure, especially when ventricular size is unchanged.
  • The study confirms 3D vPCA enhances diagnostic certainty in pediatric shunt malfunction cases.
Abstract

Keywords:
CSF dynamicsHydrocephalusIntracranial pressureVenous sinusVentriculomegaly

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