• Saif Afat, Rastislav Pjontek, Hussam A Hamou, Klaus Herz, Omid Nikoubashman, Fabian Bamberg, Marc A Brockmann, Konstantin Nikolaou, Hans Clusmann, Martin Wiesmann, and Ahmed E Othman.
• From the *Department of Diagnostic and Interventional Neuroradiology, †Department of Neurosurgery, Uniklinik RWTH Aachen, Aachen; ‡Department of Radiation Protection, §Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, University Hospital Tuebingen, Tübingen; ∥Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz; and ¶Institute of Neuroscience and Medicine 4, Forschungszentrum Jülich GmbH, Jülich, Germany.
• J Comput Assist Tomogr. 2016 Nov 1; 40 (6): 991-996.

ObjectiveTo determine diagnostic value and radiation exposure of low-dose computed tomography (LD-CT) compared to radiographic shunt series (SS) for the detection of ventriculoperitoneal (VP) shunt complications.MethodsFourteen VP shunts were implanted in 7 swine cadavers. Mechanical complications were induced in 50% of VP shunts. Low-dose CT (80 kVp, 10 mAs, Pitch = 1.5) and SS were acquired. Dose area product (DAP) and effective doses for SS and LD-CT were collected. Scoring of diagnostic confidence and blinded readings of SS and CT data were performed.ResultsThe sensitivity of LD-CT was high (0.97; 95% confidence interval, 0.91-1.00) with excellent interobserver agreement (κ = 0.88). Similarly, the sensitivity of SS was high (0.82; 95% confidence interval, 0.68-0.95) with good interobserver agreement (κ = 0.68). In contrast, LD-CT was associated with significantly higher diagnostic confidence (4.64 ± 0.41 vs 2.71 ± 0.73; P < 0.01) and significantly lower radiation exposure (effective dose: 0.26 mSv vs 1.06 mSv; DAP: 265.4 μGym vs 724.8 μGym; P < 0.001).ConclusionsFor the assessment of suspected VP shunt complications, LD-CT provides excellent sensitivity and higher diagnostic confidence with lower radiation exposure compared with SS.

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