Development and implementation of an ultralow-dose CT protocol for the assessment of cerebrospinal shunts in adult hydrocephalus

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dc.contributor.authorRyan, David J.
dc.contributor.authorKavanagh, Richard G.
dc.contributor.authorJoyce, Stella
dc.contributor.authorO'Callaghan Maher, Mika
dc.contributor.authorMoore, Niamh
dc.contributor.authorMcMahon, Aisling
dc.contributor.authorHussey, Deirdre
dc.contributor.authorO'Sullivan, Michael G. J.
dc.contributor.authorWyse, Gerald
dc.contributor.authorFanning, Noel
dc.contributor.authorO'Connor, Owen J.
dc.contributor.authorMaher, Michael M.
dc.contributor.funderScience Foundation Irelanden
dc.date.accessioned2021-07-01T09:48:03Z
dc.date.available2021-07-01T09:48:03Z
dc.date.issued2021-06-28
dc.date.updated2021-06-28T12:52:25Z
dc.description.abstractBackground: Cerebrospinal fluid shunts in the treatment of hydrocephalus, although associated with clinical benefit, have a high failure rate with repeat computed tomography (CT) imaging resulting in a substantial cumulative radiation dose. Therefore, we sought to develop a whole-body ultralow-dose (ULD) CT protocol for the investigation of shunt malfunction and compare it with the reference standard, plain radiographic shunt series (PRSS). Methods: Following ethical approval, using an anthropomorphic phantom and a human cadaveric ventriculoperitoneal shunt model, a whole-body ULD-CT protocol incorporating two iterative reconstruction (IR) algorithms, pure IR and hybrid IR, including 60% filtered back projection and 40% IR was evaluated in 18 adult patients post new shunt implantation or where shunt malfunction was suspected. Effective dose (ED) and image quality were analysed. Results: ULD-CT permitted a 36% radiation dose reduction (median ED 0.16 mSv, range 0.07–0.17, versus 0.25 mSv (0.06–1.69 mSv) for PRSS (p = 0.002). Shunt visualisation in the thoracoabdominal cavities was improved with ULD-CT with pure IR (p = 0.004 and p = 0.031, respectively) and, in contrast to PRSS, permitted visualisation of the entire shunt course (p < 0.001), the distal shunt entry point and location of the shunt tip in all cases. For shunt complications, ULD-CT had a perfect specificity. False positives (3/22, 13.6%) were observed with PRSS. Conclusions: At a significantly reduced radiation dose, whole body ULD-CT with pure IR demonstrated diagnostic superiority over PRSS in the evaluation of cerebrospinal fluid shunt malfunction.en
dc.description.statusPeer revieweden
dc.description.versionPublished Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.articleid26en
dc.identifier.citationRyan, D. J., Kavanagh, R. G., Joyce, S., O’Callaghan Maher, M., Moore, N., McMahon, A., Hussey, D., O’Sullivan, M. G. J., Wyse, G., Fanning, N., O’Connor, O. J. and Maher, M. M. (2021) 'Development and implementation of an ultralow-dose CT protocol for the assessment of cerebrospinal shunts in adult hydrocephalus', European Radiology Experimental, 5(1), 26 (15 pp). doi: 10.1186/s41747-021-00222-4en
dc.identifier.doi10.1186/s41747-021-00222-4en
dc.identifier.endpage15en
dc.identifier.issn2509-9280
dc.identifier.journaltitleEuropean Radiologyen
dc.identifier.startpage1en
dc.identifier.urihttps://hdl.handle.net/10468/11520
dc.identifier.volume5en
dc.language.isoenen
dc.publisherSpringeren
dc.relation.projectinfo:eu-repo/grantAgreement/SFI/SFI Research Centres/12/RC/2273/IE/Alimentary Pharmabiotic Centre (APC) - Interfacing Food & Medicine/en
dc.relation.urihttps://eurradiolexp.springeropen.com/articles/10.1186/s41747-021-00222-4
dc.rights© The Author(s). 2021 Open Access. This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/en
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en
dc.subjectCTen
dc.subjectVP shunten
dc.subjectLow dose CTen
dc.subjectAdulten
dc.subjectCerebrospinal fluid shuntsen
dc.subjectHydrocephalusen
dc.subjectRadiation dosageen
dc.subjectTomography (x-ray, computed)en
dc.titleDevelopment and implementation of an ultralow-dose CT protocol for the assessment of cerebrospinal shunts in adult hydrocephalusen
dc.typeArticle (peer-reviewed)en
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