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Updated: Oct 18, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Quantitative MRI to assess baseline shunt flow in patients with hydrocephalus: a noninvasive tool to aid clinical
Joseph H Ha1, Madison E Gutierrez2, Jason M Toliao3,4
11Stanford University School of Medicine, Palo Alto.
Objective:
Hydrocephalus is a common yet serious condition, and ventricular shunts are used for lifesaving CSF diversion. Existing methods for shunt evaluation provide correlative/qualitative information, leading to commonplace clinical diagnostic challenges. The aim of this study was to determine accurate and noninvasive measures of volumetric CSF flow rates through ventricular shunts using the phase-contrast (PC) sequence in routine MRI for pediatric patients with hydrocephalus.
Methods:
The authors conducted a prospective observational cohort study of patients with ventricular shunts who underwent a clinically indicated brain MRI and the adjunct PC-MRI shunt flow sequence at a single center between January 2023 and January 2024. At the study institution, PC-MRI has been integrated as a supplementary imaging technique to quantify shunt flow alongside fast protocol MRI for shunted patients. Clinical and imaging data were collected. Data distributions and paired changes in flow measurements over time were assessed using appropriate statistical tests.
Results:
Overall, 207 patients (107 male, mean age 11.3 years [range 8 days-27 years]) who underwent PC-MRI were included; 98% had a VP shunt. The mean CSF flow rate was 9.9 ± 8 mL/hour (range 0.5-54 mL/hour). No significant differences were noted by age, sex, etiology of hydrocephalus, valve type, time interval since shunt placement, BMI, fronto-occipital horn ratio, and frontal horn or atrial width. Repeat PC-MRI was performed in 11 patients, and there was no significant difference in flow measurements between initial and follow-up images (p = 0.83) among these patients. PC-MRI identified alterations that accurately demonstrated failure in 3 patients and avoided unnecessary surgery in a fourth patient.
Conclusions:
Addition of PC-MRI to routine imaging examinations in patients with ventricular shunts accurately and noninvasively measured CSF shunt flow. Flow rate data can provide supplementary information regarding shunt function and serve as a baseline for future comparison assessments. These findings suggest a role for routine acquisition of patient-specific baseline shunt flow measurement in shunted pediatric patients with hydrocephalus.
