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Related Experiment Video

Updated: Jan 15, 2026

Four-Dimensional Computed Tomography-Guided Valve Sizing for Transcatheter Pulmonary Valve Replacement

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Assessment of VP Shunt Valve Settings Using Reconstructions from Non-Contrast Head CT: A Comparative Study with

Raya Juliane Ocker-Serger¹, Hanna Styczen², Yan Li²

¹Institute of Diagnostic and Interventional Radiology and Neuroradiology, Essen University Hospital, Essen, Germany. raya.ocker-serger@uk-essen.de.

Clinical Neuroradiology

|January 14, 2026

Summary

Maximum intensity projection (MIP) from head CT scans reliably assesses ventriculoperitoneal (VP) shunt valve settings, potentially reducing the need for X-rays. This method offers a viable alternative for shunt evaluation.

Keywords:

Cerebrospinal Fluid Shunts Computed tomography Hydrocephalus Image Processing Maximum intensity projection Radiation Exposure

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Retrospective Cardiac Gating with A Prototype Small-Animal X-ray Computed Tomograph

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Published on: February 21, 2025

Area of Science:

Neurosurgery
Radiology
Medical Imaging

Background:

Ventriculoperitoneal (VP) shunts are crucial for managing hydrocephalus.
Accurate assessment of programmable VP shunt valve settings is essential for effective treatment.
Conventional methods for valve assessment include lateral skull radiographs.

Purpose of the Study:

To determine if maximum intensity projection (MIP) reconstructions from non-contrast head CT scans can reliably assess VP shunt valve settings.
To compare the performance of MIP reconstructions against conventional lateral skull radiographs for VP shunt valve assessment.

Main Methods:

Retrospective analysis of 41 adult patients with Codman Certas programmable VP shunt valves.
Comparison of same-day lateral skull X-rays and non-contrast head CT scans.
Generation of MIP reconstructions from CT data for valve region analysis.
Independent blinded assessment of valve settings and image quality by three neuroradiologists using a 5-point Likert scale.

Main Results:

Valve settings were identifiable in 100% of CT/X-ray pairs, with 95% agreement between MIP and X-ray readings.
MIP reconstructions were successfully generated with a median CTDIvol of 35.34 mGy.
Image quality was rated lower for MIP (median 2) than for X-ray (median 4), but MIP quality was significantly higher with photon-counting CT.
Good inter-reader reliability was observed for MIPs (ICC=0.82) and excellent for X-rays (ICC=0.97).

Conclusions:

Maximum intensity projection (MIP) from non-contrast head CT scans provides a reliable method for assessing VP shunt valve settings.
This technique may reduce the necessity for additional radiographic imaging, particularly when utilizing advanced CT systems.
MIP offers a valuable alternative for evaluating programmable VP shunt function.