LEARN NUCLEAR MEDICINE
Neurology · Case 03
Read the history, inspect the study, then reveal the teaching.
IMAGE PLACEHOLDER · Diagnostic study
Original study · Companion image placeholders
Clinical history
A 21-year-old male presents to the hospital with ataxia and urinary incontinence. The patient has a known history of hydrocephalus. Radiographs were performed and demonstrated disruption of the patient’s known ventriculoperitoneal shunt in the patient’s neck. A nuclear medicine shuntogram study was performed to evaluate shunt function.
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Preservation on shunt function despite the disruption of the shunt tubing.
Imaging Findings
A radiotracer was injected into the right-sided shunt reservoir. In delayed images, normal propagation of the radiotracer can be seen from the head to the abdomen. There is spread throughout the abdominal cavity as expected.
Essential Facts
Communicating and noncommunicating hydrocephalus is often treated with a ventriculoperitoneal (VP) shunt.
VP shunting is a procedure that relieves pressure on the brain caused by an inappropriate accumulation of CSF.
Malfunction of these diversionary CSF shunts is a common complication of the procedure.
Nuclear Medicine shuntograms can be performed to evaluate shunt patency. Not only should activity transit from the shunt into the abdomen, but a normal study will demonstrate activity spreading diffusely into the abdomen.
References
“Central Nervous System.” Essentials of Nuclear Medicine Imaging, by Fred A. Mettler and Milton J. Guiberteau, Elsevier Saunders, 2012, pp. 71–97.