| 11. Subramaniam S, Chen AE, Khwaja A, Rempell R. Identifying infant hydrocephalus in the emergency department with transfontanellar POCUS. Am J Emerg Med. 2019 Jan;37(1):S0735-6757(18)30823-4. |
Review/Other-Dx |
N/A |
This review is to provide the emergency physician with a succinct overview of infant hydrocephalus and the point-of-care ultrasound (POCUS) technique for identification of this pathology. |
No results stated in the abstract. |
4 |
| 12. Radhakrishnan R, Brown BP, Kralik SF, et al. Frontal Occipital and Frontal Temporal Horn Ratios: Comparison and Validation of Head Ultrasound-Derived Indexes With MRI and Ventricular Volumes in Infantile Ventriculomegaly. AJR Am J Roentgenol. 2019 Oct;213(4):925-931. |
Observational-Dx |
90 infants |
Our aim in this study was to assess whether ultrasound (US)-derived Frontal Occipital Horn Ratios (FOHR) and Frontal Occipital and Horn Ratios (FTHR) are reliable measures of ventriculomegaly in infants using magnetic resonance imaging (MRI) ventricular volume assessment as the reference standard. Our hypothesis was that these US-derived measures are concordant with MRI-derived indexes. |
Bland-Altman plots of the FOHR and FTHR between US and MRI showed excellent concordance with a bias of 0.05 (95% CI, -0.04 to 0.14) and 0.03 (95% CI, -0.06 to 0.13), respectively. There was good-to-excellent interobserver concordance for FOHR and FTHR on head US or MRI (r = 0.86-0.96). There was good correlation between ventricle-to-intracranial volume ratios and US- and MRI-derived FOHRs and FTHRs (r = 0.79-0.87). |
2 |
| 13. Ucar M, Tokgoz N, Damar C, Alimli AG, Oncu F. Diagnostic performance of heavily T2-weighted techniques in obstructive hydrocephalus: comparison study of two different 3D heavily T2-weighted and conventional T2-weighted sequences. Jpn J Radiol. 2015 Feb;33(2):94-101. |
Review/Other-Dx |
62 patients diagnosed with intraventricular obstructive hydrocephalus |
To evaluate efficacy of three-dimensional (3D) heavily T2-weighted (W) MRI sequences in assessment of cerebrospinal fluid (CSF) pathways and to compare two different types of 3D heavily T2W MRI sequences (CISS and SPACE) with two-dimensional (2D) T2W turbo spin echo (TSE) sequences for hydrocephalus with intraventricular obstruction. |
CNR between CSF and brain parenchyma was significantly higher using 3D-SPACE sequences compared with 3D-CISS and 2D-TSE-T2 sequences. The qualitative findings showed that 3D heavily T2W sequences were superior to 2D-TSE-T2 sequences. 3D-SPACE sequences showed fewer artifacts than 3D-CISS or 2D-TSE-T2 sequences. |
4 |
| 14. Mohammad SA, Osman NM, Khalil RM. Phase-contrast and three-dimensional driven equilibrium (3D-DRIVE) sequences in the assessment of paediatric obstructive hydrocephalus. Childs Nerv Syst. 2018 Nov;34(11):2223-2231. |
Review/Other-Dx |
25 brain MRIs |
To describe the phase-contrast and 3D-DRIVE findings in cases of obstructive hydrocephalus in paediatric patients and to determine their functional and anatomical correlates. |
Aqueduct of Sylvius was the most common site of obstruction (19 patients) either secondary to focal, multifocal or tubular stenosis, adhesions, or secondary to extrinsic compression. Functional and anatomical correlation was analysed in 58 regions revealing strong correlation (ro = 0.8, p < .001). Functional anatomical mismatch was found in nine regions. Flow velocity measurements revealed diminished flow in most of the cases with obstruction at the aqueduct and normal velocity in cases with obstruction proximal to aqueductal level, while accelerated flow was seen in cases with infra-aqeuductal obstruction. |
4 |
| 15. Shi J, Fu W, Wu Q, Zhang H, Zheng Z, Zhu J. Endoscopic third ventriculostomy associated 3D-construcive inference steady state MRI for obstructed hydrocephalus: a retrospective study. Clin Neurol Neurosurg. 2013 Jul;115(7):S0303-8467(12)00477-5. |
Review/Other-Dx |
46 patients with an existing obstruction below the posterior part of the third ventricle underwent 3D CISS sequence MRI |
To determine the relevance of third ventricle diagnostic imaging by three-dimensional constructive inference in steady state (3D CISS) MRI in patients with OH and to access the preoperative and postoperative values of this technique in patients undergoing endoscopic third ventriculostomy (ETV). |
By virtue of 3D-CISS 97.83% third ventricle floors and 91.30% basilar arteries (BA) could be visualized, and there was a positive correlation between TVE and HD and a negative correlation between TVE and TVFT in this group. All incision sites on the scalp could be marked correctly. The degree of enlargement of the third ventricle allowed a prediction of the technical challenge to puncture the third ventricle floor. The position and route of BA could be demonstrated avoiding intraoperative iatrogenic lesions. At follow-up, 100% of the fistulas of the third ventricle floor could be measured on 3D-CISS images. The mean diameter of the fistulas was 6.12±0.96 mm; in 91.67%, new CSF fluid directions could be demonstrated; in 83.33%, enlarged ventricle system got withdrawn, and 91.67% patients showed relief of initial symptoms. 1 patient needed the implantation of a ventriculoperitoneal shunt 7 months after EVT. The preoperative HD compared with postoperative HD (P<.01); the preoperative TVE compared with postoperative TVE (P<.05). |
4 |
| 16. Verhey LH, Kulkarni AV, Reeder RW, et al. A re-evaluation of the Endoscopic Third Ventriculostomy Success Score: a Hydrocephalus Clinical Research Network study. J Neurosurg Pediatr. 2024 May 01;33(5):417-427. |
Observational-Dx |
761 children who underwent a first-time ETV for hydrocephalus |
1) To determine if a new, better-performing version of the Endoscopic Third Ventriculostomy Success Score (ETVSS) could be developed, 2) to explore the performance characteristics of the original ETVSS in a modern endoscopic third ventriculostomy (ETV) cohort, and 3) to determine if the addition of radiological variables to the ETVSS improved its predictive abilities. |
Seven hundred sixty-one children underwent a first-time ETV. The rate of 6-month ETV success was 76%. The Hosmer-Lemeshow and Harrell's C statistics of the logistic model containing more granular age and etiology categorizations did not differ significantly from a model containing the ETVSS categories. In children = 12 months of age with ETVSSs of 50 or 60, the original ETVSS underestimated success, but this analysis was limited by a small sample size. Fronto-occipital horn ratio (p = 0.37), maximum width of the third ventricle (p = 0.39), and downward concavity of the floor of the third ventricle (p = 0.63) did not predict ETV success. A possible association between the degree of prepontine adhesions on preoperative MRI and ETV success was detected, but this did not reach statistical significance. |
4 |
| 17. Harrington SG, Jaimes C, Weagle KM, Greer MC, Gee MS. Strategies to perform magnetic resonance imaging in infants and young children without sedation. Pediatr Radiol. 2022 Feb;52(2):374-381. |
Review/Other-Dx |
N/A |
To focus on current techniques to facilitate non-sedation MRI in children, including exam preparation with MRI simulation; asleep but not sedated techniques; awake and relaxed techniques using certified child life specialists, animal-assisted therapy, a child-friendly environment and in-scan entertainment; and non-sedated MRI protocol modifications such as shorter scan time, prioritizing sequences, reducing motion artifact, noise reduction, limiting use of gadolinium, employing an open MRI and modifying protocols. |
No results stated in abstract. |
4 |
| 18. O'Neill BR, Pruthi S, Bains H, et al. Rapid sequence magnetic resonance imaging in the assessment of children with hydrocephalus. World Neurosurg. 2013 Dec;80(6):S1878-8750(12)01240-5. |
Review/Other-Dx |
50 patients with implanted shunts (29 male; 21 female) underwent 119 RS-MRIs |
To review our experience with RS-MRI in children with shunts. |
Image quality was very good or excellent in 94% of studies, whereas only one was graded as poor. Significant motion artifact was noted in 7%, whereas 77% had little or no motion artifact. Catheter visualization was good or excellent in 57%, poor in 36%, and misleading in 7%. Small ventricular size was correlated with poor catheter visualization (Spearman's ? = 0.586; P < 0.00001). RS-MRI imaging cost ~$650 more than conventional computed tomography (CT). |
4 |
| 19. Patel DM, Tubbs RS, Pate G, Johnston JM, Blount JP. Fast-sequence MRI studies for surveillance imaging in pediatric hydrocephalus. J Neurosurg Pediatr. 2014 Apr;13(4):440-7. |
Review/Other-Dx |
200 |
To present imaging paradigms and report here a 5-year experience with fast-sequence MRI. |
Two hundred patients underwent fsMRI. No child required sedation. The average duration of examinations was approximately 3.37 minutes, and mean age of the patients was 5.7 years. Clinically useful images were attained in all cases. Overall quality of the fsMRI studies based on the 5 different visibility parameters showed that 169 images (84.5%) included 4 or 5 parameters (score = 4) and had statistically significant excellent quality. The Kendall's tau-b for the overall fsMRI ratings was 0.82 (p = 0.002) and the intraclass coefficient was 0.87 (p < 0.0001). |
4 |
| 20. Kralik SF, Vallejo JG, Kukreja MK, et al. Diagnostic Accuracy of MRI for Detection of Meningitis in Infants. AJNR Am J Neuroradiol. 2022 Sep;43(9):1350-1355. |
Observational-Dx |
209 infants less than 1 year of age who underwent a brain MR imaging for meningitis |
To determine the accuracy of MR imaging for diagnosis of meningitis in infants. |
Two hundred nine infants with mean age 80 days (range 0-347 days) were included. There were 178 true positives with the most common pathogens being: Group B Streptococcus (58), E. coli (50), Streptococcus pneumoniae (21), H. influenzae (4); Herpes simplex virus 1 or 2 (18); Enterovirus (4); and other (23). There were 31 true negatives. Range of sensitivity, specificity, PPV, NPV, and accuracy of MR imaging for detection of meningitis was 67.4-83.5%, 92.3-95.7%, 95.0-98.6%, 33.3-76.5%, and 71.3-86.5% respectively. MR imaging sensitivity decreased after 10 days from time of presentation while specificity remained stable. Among individual MR imaging findings, leptomeningeal enhancement was the most sensitive finding, while cerebritis, infarction, ventriculitis, abscess, and intraventricular purulent material were the most specific findings. |
3 |
| 21. Gabriel S, Eckel LJ, DeLone DR, et al. Pilot study of radiation dose reduction for pediatric head CT in evaluation of ventricular size. AJNR Am J Neuroradiol. 2014 Dec;35(12):2237-42. |
Observational-Dx |
22 patients |
To determine the minimum dose output or CT dose index required to produce clinically acceptable examinations. |
There was no significant difference in the ventricular size ranking, and the sensitivity for moderate to severe hydrocephalus was 100%. There was no significant difference between the full-dose level and the ventricular size rankings at the 25% or the 10% dose level for either reconstruction kernel (P > .979). Diagnostic confidence was maintained across doses and kernel. Hemorrhage was more difficult to identify as image quality degraded as dose decreased but was still seen in a majority of cases. Shunts were identified by all readers across all doses and reconstruction methods. |
2 |
| 22. Wallace AN, Vyhmeister R, Bagade S, et al. Evaluation of the use of automatic exposure control and automatic tube potential selection in low-dose cerebrospinal fluid shunt head CT. Neuroradiology. 2015 Jun;57(6):639-44. |
Observational-Dx |
60 non-contrast head CT scans assessing for cerebrospinal fluid shunt malfunction |
To evaluate the reduction in radiation dose achieved by this protocol compared with a protocol with fixed parameters. |
The new protocol lowered the average volume CT dose index from 15.2 to 9.2 mGy representing a 39 % reduction (P < 0.01; 95 % CI 35-44 %) and lowered the dose length product from 259.5 to 151.2 mGy/cm representing a 42 % reduction (P < 0.01; 95 % CI 34-50 %). The new protocol produced diagnostically acceptable scans with comparable image quality to the fixed parameter protocol. |
3 |
| 26. Algin O, Ucar M, Ozmen E, et al. Assessment of third ventriculostomy patency with the 3D-SPACE technique: a preliminary multicenter research study. J Neurosurg. 2015 Jun;122(6):1347-55. |
Review/Other-Dx |
26 patients |
To determine the value of the 3D sampling perfection with application-optimized contrasts using different flip-angle evolutions (3D-SPACE) technique in the evaluation of endoscopic third ventriculostomy (ETV) patency. |
The mean area, flow, and velocity values measured at the level of stoma in patients with patent stoma were significantly higher than those measured in patients with closed stoma (p < 0.05). There was significant correlation among PC-MRI, 3D-SPACE, and 3D heavily T2W techniques regarding assessment of ETV patency (p < 0.001). The 3D-SPACE technique provided the lowest rate of ambiguous results. |
4 |
| 27. Dinçer A, Yildiz E, Kohan S, Memet Özek M. Analysis of endoscopic third ventriculostomy patency by MRI: value of different pulse sequences, the sequence parameters, and the imaging planes for investigation of flow void. Childs Nerv Syst. 2011 Jan;27(1):127-35. |
Observational-Dx |
46 patients |
To evaluate the efficiency of turbo spin-echo (TSE), three-dimensional constructive interference in the steady state (3D CISS) and cine phase contrast (Cine PC) sequences in determining flow through the endoscopic third ventriculostomy (ETV) fenestration, and to determine the effect of various TSE sequence parameters. |
Bidirectional flow through the fenestration was detected in all group I patients by cine PC. Stroke volumes through the fenestration in group I ranged 10-160.8 ml/min. There was no correlation between the presence of reversed flow and flow void grading. Also, there was no correlation between the stroke volumes and flow void grading. The sensitivity of 3D CISS was low, and 2 mm sagittal TSE T2, nearly equal to cine PC, provided best result. |
3 |
| 28. Sampson MA, Berg AD, Huber JN, Olgun G. Necessity of Intracranial Imaging in Infants and Children With Macrocephaly. Pediatr Neurol. 2019 Apr;93():S0887-8994(18)30900-7. |
Review/Other-Dx |
169 patients |
To identify risk factors for pathologic macrocephaly and to aid the clinician in identifying patients that would benefit from imaging. |
A total of 169 patients were included in the analysis. Imaging modalities included 39 magnetic resonance imagings (23.1%), 47 cranial computed tomographies (27.8%), and 83 head ultrasounds (49.1%). Imaging results demonstrated 13 abnormal studies with five of those studies being abnormal with high clinical yield. Patients with abnormal studies were more likely to have developmental delay (P = 0.04) or neurological symptoms (P = 0.015). Positive family history of macrocephaly was predictive of normal imaging (P = 0.004). There were no sedation complications. |
4 |
| 29. Thomas CN, Kolbe AB, Binkovitz LA, McDonald JS, Thomas KB. Asymptomatic macrocephaly: to scan or not to scan. Pediatr Radiol. 2021 May;51(5):811-821. |
Review/Other-Dx |
490 infants |
To determine the utility of screening head ultrasound (US) in asymptomatic infants with macrocephaly and to identify clinical factors associated with significant US findings. |
Four hundred and forty infants met inclusion criteria. Two hundred and eighty studies (64%) were found to be normal, 137 (31%) had incidental findings, 17 (3.8%) had indeterminate but potentially significant findings, and 6 (1.4%) had significant findings. Twenty of the 23 infants with indeterminate or significant findings had subsequent CT or MRI. This confirmed significant findings in eight infants (1.8%): three subdural hematomas, two intracranial tumors, two aqueductal stenoses, and one middle fossa cyst. Five of the eight infants required surgical procedures. The only statistically significant association found with having a significant finding on head US was head circumference at birth. |
4 |
| 33. Haws ME, Linscott L, Thomas C, Orscheln E, Radhakrishnan R, Kline-Fath B. A Retrospective Analysis of the Utility of Head Computed Tomography and/or Magnetic Resonance Imaging in the Management of Benign Macrocrania. J Pediatr. 2017 Mar;182():S0022-3476(16)31262-8. |
Review/Other-Dx |
466 patients |
To assess whether computed tomography (CT), magnetic resonance imaging (MRI), and neurosurgical evaluations altered the diagnosis or management of children diagnosed with benign macrocrania of infancy by ultrasonography (US). |
Patients with benign macrocrania of infancy (n = 466) were identified (mean age at diagnosis: 6.5 months). Eighty-four patients (18.0%) received subsequent head CT/MRI; of these, 10 patients had neurologic abnormalities before 2 years of age, of which 3 had significant findings on MRI (temporal lobe white matter changes, dysmorphic ventricles, thinned corpus callosum). One patient without neurologic abnormalities had nonspecific white matter signal abnormality (stable over 6 months) but no change in management. None required neurosurgical intervention. Another 9/84 patients had incidental findings including Chiari I (3), small subdural bleeds (2), arachnoid cyst (1), small cavernous malformation (1), frontal bone dermoid (1), and a linear parietal bone fracture after a fall (1). |
4 |
| 35. Naffaa L, Rubin M, Stamler AC, Haddad M, Saade C. The diagnostic yield of ultrasound of the head in healthy infants presenting with the clinical diagnosis of benign macrocrania. Clin Radiol. 2017 Jan;72(1):S0009-9260(16)30346-4. |
Review/Other-Dx |
326 patients |
To investigate the frequency of sonographic findings that required neurosurgical consultation for all referred outpatients suspected to have benign macrocrania (BMC). |
One hundred and thirty (40.9%) had a normal head US, 181 patients (56.9%) had sonographic findings of BMC, and seven (2.2%) patients had an abnormal head US that required a neurosurgical consultation. Of the 181 patients with BMC, 23 underwent follow-up imagingwith 22 patients having unchanged BMC or a normal head US and one patient developing mild ventriculomegaly that was stable on follow-up imaging. Three of the seven patients (1%) aged 1.8, 2.3, and 13.1 months with abnormal head US requiring neurosurgical consultation, had mild ventriculomegaly that was stable on follow-up imaging. Four of the seven patients (1.2%) that required neurosurgical consultation needed a neurosurgical procedure. Between the two US subgroups (normal and BMC), no statistical significance was noted regarding age of patient at US, head circumference at clinical and radiological presentation (p>0.05) except for the first head circumference clinically documented which demonstrated statistical significance (p<0.03). |
4 |
| 36. Missios S, Quebada PB, Forero JA, et al. Quick-brain magnetic resonance imaging for nonhydrocephalus indications. J Neurosurg Pediatr. 2008 Dec;2(6):438-44. |
Review/Other-Dx |
1146 consecutive QB MR imaging studies |
In 2002, "quick-brain" (QB) MR imaging (ultrafast spin echo T2-weighted imaging) was introduced as an alternative technique to CT scanning for assessing children with hydrocephalus. The authors have observed high patient and physician satisfaction with this technique at their institution, which has led to an increasing frequency of its use for nonhydrocephalic indications. The goal in this study was to characterize, quantitate, and assess the use of "quick-brain" (QB) magnetic resonance imaging for these additional indications. |
The total number of QB imaging studies performed increased each year. The proportion of studies performed for nonhydrocephalic indications also increased (from 23 to 50%). The most common indication was screening for macrocephaly, and all other indications were nearly evenly distributed. Quick-brain MR imaging was used extensively for the initial evaluation and follow-up in patients with little need for additional studies. Its false-negative rate, however, remains unknown. |
4 |
| 40. Desai KR, Babb JS, Amodio JB. The utility of the plain radiograph "shunt series" in the evaluation of suspected ventriculoperitoneal shunt failure in pediatric patients. Pediatr Radiol. 2007 May;37(5):452-6. |
Review/Other-Dx |
238 children |
To determine the accuracy of plain radiography in diagnosing VP shunt failure in children in whom shunt malfunction is clinically suspected. |
Just 6.72% of patients demonstrated plain radiographic signs of shunt failure. Of patients with normal plain radiographs, 43% demonstrated shunt abnormalities on CT, MRI or cisternography. Statistical analysis indicated that no more than 10.46% (P < 0.05) of plain radiographs showed signs of failure and that the sensitivity of plain radiography for the detection of VP shunt failure is no higher than 31%. Furthermore, there was poor agreement between the results of plain radiography and those of CT, MRI and cisternography. |
4 |
| 41. Pujara S, Natalwala A, Robertson I. Referrals for suspected ventriculo-peritoneal shunt dysfunction and necessity for further imaging. Br J Neurosurg. 2017 Jun;31(3):320-321. |
Review/Other-Dx |
N/A |
Shunt series (SS) X-rays are often performed as additional routine initial investigations for suspected ventriculo-peritoneal shunt dysfunction, despite low diagnostic utility and radiological implications. |
No results stated in abstract. |
4 |
| 42. Florin TA, Aronson PL, Hall M, et al. Emergency Department Use of Computed Tomography for Children with Ventricular Shunts. J Pediatr. 2015 Dec;167(6):S0022-3476(15)01028-8. |
Review/Other-Dx |
1319 patients |
To quantify rates and variation in emergency department (ED) cranial computed tomography (CT) utilization in children with ventricular shunts, estimate radiation exposure, and evaluate the association between CT utilization and shunt revision. |
The 1319 children with initial shunt placed in 2003 experienced 6636 ED visits during the subsequent decade. A cranial CT was obtained in 49.4% of all ED visits; 19.9% of ED visits with CT were associated with a shunt revision. Approximately 6% of patients received =10 CTs, accounting for 37.2% of all ED visits with a CT. The mean number of CTs per patient varied nearly 20-fold across hospitals; the individual hospital accounted for the most variation in CT utilization. The median (IQR) cumulative effective radiation dose was 7.2 millisieverts (3.6-14.0) overall, and 33.4 millisieverts (27.2-43.8) among patients receiving =10 CTs. |
4 |
| 43. Antonucci MC, Zuckerbraun NS, Tyler-Kabara EC, Furtado AD, Murphy ME, Marin JR. The Burden of Ionizing Radiation Studies in Children with Ventricular Shunts. J Pediatr. 2017 Mar;182():S0022-3476(16)31354-3. |
Review/Other-Dx |
178 patients with ventricular shunts |
To quantify the number of shunt-related imaging studies that patients with ventricular shunts undergo and to calculate the proportion of computed tomography (CT) scans associated with a surgical intervention. |
Patients (n = 130) followed over 10 years comprised the study cohort. The most common reasons for shunt placement were congenital hydrocephalus (30%), obstructive hydrocephalus (19%), and atraumatic hemorrhage (18%), and 97% of shunts were ventriculoperitoneal. Patients underwent a median of 8.5 head CTs, 3.0 shunt series radiographs, 1.0 skull radiographs, 0 nuclear medicine studies, and 1.0 brain magnetic resonance imaging scans over the 10 years following shunt placement. The frequency of head CT scans was greatest in the first year after shunt placement (median 2.0 CTs). Of 1411 head CTs in the cohort, 237 resulted in surgical intervention within 7 days (17%, 95% CI 15%-19%). |
4 |
| 44. Khalatbari H, Parisi MT. Complications of CSF Shunts in Pediatrics: Functional Assessment With CSF Shunt Scintigraphy-Performance and Interpretation. AJR Am J Roentgenol. 2020 Dec;215(6):1474-1489. |
Review/Other-Dx |
N/A |
The purpose of this article is to review the performance method and criteria for interpretation of cerebrospinal fluid (CSF) shunt scintigraphy studies. |
Interpretation of CSF shunt scintigraphy studies requires an in-depth understanding of hydrocephalus, the functioning of CSF shunts and their components, and the mechanisms of failure of such devices. Application of strict interpretive criteria when evaluating CSF shunt scintigraphy studies improves diagnostic yield, providing valuable functional information to the neurosurgical team who manages patients with shunted hydrocephalus. |
4 |
| 45. Thompson EM, Wagner K, Kronfeld K, Selden NR. Using a 2-variable method in radionuclide shuntography to predict shunt patency. J Neurosurg. 2014 Dec;121(6):1504-7. |
Observational-Dx |
259 shuntograms |
To aid in the clinical interpretation of a variety of shuntography results and to determine the applicability of shuntography in different patient populations. |
Median patient age was 19 years, and 51% of patients were male. The most common presentation in patients undergoing shuntography was headache (169/254, 66.5%) with radiographically stable ventricle size. Of 227 patients with available imaging data, 163 (71.8%) presented with the same ventricle size as shown on a previous asymptomatic scan, 43 (18.9%) had larger ventricles, and 21 (9.2%) had smaller ventricles. Within 30 days of shuntography, 74 of 259 patients (28.6%) underwent surgical shunt exploration: 65 were found to have an obstructed shunt and 9 were found to have a patent shunt. Of those patients not undergoing surgery, the median length of benign clinical follow-up was 1051 days. Clinical variables were not significantly associated with shuntography results, including valve type (p = 0.180), ventricle size (p = 0.556), age (p = 0.549), distal drainage site (p = 0.098), and hydrocephalus etiology (p = 0.937). Shuntography results of patients with myelomeningocele were not dissociable from those of the group as a whole. Sensitivity to diagnose shunt failure was lowest (37.5%) but specificity was highest (97.2%) when the definition of a "normal" shuntogram included any tracer movement into the distal site within 45 minutes. Conversely, sensitivity was highest (87.5%) and specificity was lowest (51.4%) when the definition was limited exclusively to tracer entry into the ventricles and distal drainage within 15 minutes. |
3 |
