Overdrainage of cerebrospinal fluid caused by detachment of the pressure control cam in a programmable valve after 3-tesla magnetic resonance imaging

2010 ◽  
Vol 112 (2) ◽  
pp. 425-427 ◽  
Author(s):  
Atsushi Watanabe ◽  
Tatsuya Seguchi ◽  
Kazuhiro Hongo
Keyword(s):  
Mr Imaging ◽  
Ct Scan ◽  
Imaging Study ◽  
Base Plate ◽  
Pressure Control ◽  
Programmable Valve ◽  
Shaped Crack ◽  
Ventricle Size ◽  
Valve Ball ◽  
White Marker

The authors report a rare case of overdrainage of the CSF caused by the malfunction of a Codman-Hakim programmable valve (CHPV) following a 3-T MR imaging procedure. Nine years ago this 72-year-old woman underwent ventriculoperitoneal shunt placement with a CHPV system for hydrocephalus due to subarachnoid hemorrhage. The postoperative course was uneventful and the system functioned well. A radiograph obtained immediately after 3-T MR imaging revealed that the pressure control cam in the valve system was detached from the base plate. Intracranial hypotension syndrome occurred several hours after the MR imaging study, and a CT scan revealed a decrease in ventricle size. A revision of the system promptly resolved the symptoms, and a postoperative CT scan revealed that the ventricle size was restored to normal. Examination of the extracted valve showed a Y-shaped crack in the plastic housing as well as detachment of the white marker and cam from the base plate. A reduction in the power of the flat spring to press the valve ball led to CSF overdrainage because of a loss of support by the cam. Because the patient had incurred no head injury during the day and radiographic studies of the system 5 years previously had shown detachment of the white marker, damage to the system might have been caused by a past impact. These facts may indicate that the antimagnetic performance of the system could have decreased due to a previous impact and that the strong magnetic force in a 3-T MR imaging environment might have caused detachment of the cam.

Reliability of the radiopharmaceutical shunt flow study for the detection of a CSF shunt malfunction in the presence of stable ventricular size

2020 ◽  
Vol 26 (4) ◽  
pp. 364-370
Author(s):  
Jeffrey J. Quezada ◽  
J. Gordon McComb
Keyword(s):  
Ct Scan ◽  
Operative Intervention ◽  
Shunt Malfunction ◽  
Shunt Revision ◽  
Csf Shunt ◽  
Technical Failure ◽  
Ventricular Size ◽  
Shunt Flow ◽  
Programmable Valve ◽  
Flow Study

OBJECTIVEThe authors sought to determine the reliability of a radiopharmaceutical (RP) shunt flow study for the detection of a CSF-diverting shunt malfunction in the presence of stable ventricular size.METHODSAfter the authors obtained IRB approval, all CSF RP shunt flow studies done between January 1, 2014, and January 1, 2019, in pediatric patients at Children’s Hospital Los Angeles were identified. Included in the study were only those patients in whom an MRI or CT scan was done during the hospital admission for shunt malfunction and showed no increase in ventricular size compared with the most recent prior MRI or CT scan when the patient was asymptomatic. Data recorded for analysis were patient age and sex, etiology of the hydrocephalus, shunt distal site, nonprogrammable versus programmable valve, operative findings if the shunt was revised, and follow-up findings for a minimum of 90 days after admission. The RP shunt flow study consisted of tapping the reservoir and injecting technetium-99m DTPA according to a set protocol.RESULTSThe authors identified 146 RP flow studies performed in 119 patients meeting the above criteria. Four of the 146 RP studies (3%) were nondiagnostic secondary to technical failure and were excluded from statistical analysis. Of the 112 normal flow studies, operative intervention was not undertaken in 102 (91%). The 10 (9%) remaining normal studies were performed in patients who underwent operative intervention, in which 8 patients had a proximal obstruction, 1 had a distal obstruction, and 1 patient had no obstruction. Of the 30 patients with abnormal flow studies, symptoms of shunt malfunction subsided in 9 (30%) patients and these patients did not undergo operative intervention. Of the 21 (70%) operated patients, obstruction was proximal in 9 patients and distal in 5, and for 7 patients the shunt tubing was either fractured or disconnected. Regression analysis indicated a significant association between the flow study interpretation and the odds for shunt revision (OR 27, 95% CI 10–75, p < 0.0001). No other clinical variables were significant. The sensitivity of a shunt flow study alone for detection of shunt malfunction in cases with stable ventricular size was the same as a shunt flow study plus an MRI or CT (70% vs 70%), but performing a shunt flow in addition to MRI or CT did increase the specificity from 92% to 100% and the accuracy from 87% to 94%.CONCLUSIONSRP shunt flow studies were of definite value in deciding whether to operatively intervene in patients with symptoms of shunt malfunction in whom no change in ventricular size was detected on current MRI or CT scans compared to scans obtained when the patients were asymptomatic.

Original Preoperative Localization Technique of Parathyroid Adenomas by 3-Dimensional Virtual Neck Exploration

2021 ◽  
pp. 155335062110012
Author(s):  
Mihaela Ignat ◽  
Madeleine Pérouse ◽  
François Lefebvre ◽  
Deborah Kadoche ◽  
Alessio Imperiale ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Ct Scan ◽  
Recurrence Rate ◽  
Imaging Study ◽  
Neck Exploration ◽  
Preoperative Imaging ◽  
Invasive Approach ◽  
Sestamibi Scan ◽  
Line Imaging

Objective. Preoperative imaging in primary hyperparathyroidism (PHPT) is essential for planning of parathyroidectomy—particularly for selection of a minimally invasive approach. The objective of this cohort study was to evaluate the diagnostic precision of 3D virtual neck exploration (3D-VNE), to evaluate its impact on choice of surgical approach, and to document the correlation with long-term outcomes. Methods. 235 consecutive patients with PHPT were studied (January 2014 to December 2018), with 6-month follow-up. 220 patients had a preoperative computed tomography (CT), 172 of these had a 3D-VNE based on the CT, and 226 patients had a Tc-99m sestamibi scan. Results. Sensitivity of exact, per gland, adenoma localization was 57.09% (95% CI: 50.85–63.10%) for nonspecialized radiologist interpretation of CT scan, 58.17% (95% CI: 51.99–64.10%) for Tc-99m sestamibi scan, and 90.21% (95% CI: 85.21–93.64%) for 3D-VNE, and thereby favoring 3D-VNE compared to CT scan alone (OR 34.5, 95% CI: 9.19–290.56%, P < 2.2 × 10−16) and to Tc-99m sestamibi scan (OR 16.25, 95% CI: 6.05–61.42%, P = 3.1 × 10−15). Specificity was 87.38% for CT scan, 86.36% for 3D-VNE, and 90% for Tc-99m sestamibi scan ( P > .05). The cure rate was 100%. The long-term recurrence rate (RR) was 2.978%. The RR was 1.324% in the video-assisted parathyroidectomy group of 151 patients and 5.952% in the group of 84 patients with cervicotomy ( P = .0459). Conclusion. CT-based 3D-VNE proved to be the most accurate localizing study in PHPT and aided in selecting patients for targeted minimally invasive parathyroidectomy, which was associated with the lower recurrence rate. 3D-VNE could be proposed as a first-line imaging study in patients with PHPT.

Accelerated spondylotic changes adjacent to the fused segment following central cervical corpectomy: magnetic resonance imaging study evidence

2004 ◽  
Vol 100 (1) ◽  
pp. 2-6 ◽  
Author(s):  
Vaijayantee Kulkarni ◽  
Vedantam Rajshekhar ◽  
Lakshminarayan Raghuram
Keyword(s):  
Magnetic Resonance ◽  
Mr Imaging ◽  
Imaging Study ◽  
Degenerative Changes ◽  
Adjacent Segment ◽  
Mr Images ◽  
Short Term ◽  
Content Type ◽  
Fine Print

Object. The authors studied whether cervical spine motion segments adjacent to a fused segment exhibit accelerated degenerative changes on short-term follow-up magnetic resonance (MR) imaging. Methods. Preoperative and short-term follow-up (mean duration 17.5 months, range 10–48 months) cervical MR images obtained in 44 patients who had undergone one- or two-level corpectomy for cervical spondylotic myelopathy were evaluated qualitatively and quantitatively. The motion segment adjacent to the fused segment and a segment remote from the fused segment were evaluated for indentation of the thecal sac, disc height, and sagittal functional diameter of the spinal canal on midsagittal T2-weighted MR images. Thecal sac indentations were classifed as mild, moderate, and severe. New indentations of the thecal sac of varying severity (mild in 17 patients [38.6%], moderate in 10 [22.7%], and severe in six [13.6%]) had developed at the adjacent segments in 33 (75%) of 44 patients. The degenerative changes were seen at the superior level in 11 patients, inferior level in 10 patients, and at both levels in 12 patients and resulted from both anterior and posterior element degeneration in the majority (23 [69.6%]) of patients. The remote segments showed mild thecal sac indentations in seven patients and moderate indentations in two patients (nine [20.5%] of 44). Compared with the changes at the remote segment, the canal size was significantly decreased at the superior adjacent segment by 0.9 mm (p = 0.007). No patient sustained a new neurological deficit due to adjacent-segment changes. Conclusions. On short-term follow-up MR imaging, levels adjacent to the fused segment exhibited more pronounced degenerative changes (compared with remote levels) in 75% of patients who had undergone one- or two-level central corpectomy.

scholarly journals Regional and Global Biventricular Function in Pulmonary Arterial Hypertension: A Cardiac MR Imaging Study

Radiology ◽  
2013 ◽  
Vol 266 (1) ◽  
pp. 114-122 ◽  
Author(s):  
Monda L. Shehata ◽  
Ahmed A. Harouni ◽  
Jan Skrok ◽  
Tamer A. Basha ◽  
Danielle Boyce ◽  
...  
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Mr Imaging ◽  
Arterial Hypertension ◽  
Imaging Study ◽  
Cardiac Mr ◽  
Biventricular Function ◽  
Pulmonary Arterial

scholarly journals Effectiveness of First-Line Management Strategies for Stage I Follicular Lymphoma: Analysis of the National LymphoCare Study

2012 ◽  
Vol 30 (27) ◽  
pp. 3368-3375 ◽  
Author(s):  
Jonathan W. Friedberg ◽  
Michelle Byrtek ◽  
Brian K. Link ◽  
Christopher Flowers ◽  
Michael Taylor ◽  
...  
Keyword(s):  
Follicular Lymphoma ◽  
Ct Scan ◽  
Systemic Therapy ◽  
Management Strategies ◽  
Imaging Study ◽  
Progression Free Survival ◽  
Stage I ◽  
Whole Body ◽  
Treatment Approaches ◽  
Positron Emission

PurposeThe optimal management of stage I follicular lymphoma, according to consensus guidelines, is based on uncontrolled experiences of select institutions. Diverse treatment approaches are used despite guidelines that recommend radiation therapy (XRT).Patients and MethodsWe analyzed outcomes of patients with stage I follicular lymphoma enrolled onto the National LymphoCare database.ResultsOf 471 patients with stage I follicular lymphoma, 206 patients underwent rigorous staging as defined by both a bone marrow aspirate and biopsy and an imaging study (a computed tomography [CT] scan of the whole body, a positron emission tomography [PET]/CT scan, or both). Rigorously staged patients had superior progression-free survival (PFS) compared with nonrigorously staged patients (hazard ratio [HR], 0.63). Treatments given to rigorously staged patients were rituximab/chemotherapy (R-chemo; 28%), XRT (27%), observation (17%), systemic therapy + XRT (13%), rituximab monotherapy (12%), and other (3%). With a median follow-up of 57 months for PFS, there were 44 progression events (in 21% of patients) for rigorously staged patients. For these patients, PFS was significantly improved with either R-chemo or systemic therapy + XRT compared with patients receiving XRT alone after adjustment for histology, LDH, and the presence of B symptoms. There were no differences in overall survival.ConclusionIn this largest, prospectively enrolled group of patients with stage I follicular lymphoma, variable treatment approaches resulted in similar excellent outcomes, which challenges the paradigm that XRT should be standard for this presentation.

Hydatid disease: MR imaging study.

Radiology ◽  
1990 ◽  
Vol 175 (3) ◽  
pp. 701-706 ◽  
Author(s):  
S A Marani ◽  
G C Canossi ◽  
F A Nicoli ◽  
G P Alberti ◽  
S G Monni ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Hydatid Disease ◽  
Imaging Study

Data-driven Grading of Brain Gliomas: A Multiparametric MR Imaging Study

Radiology ◽  
2014 ◽  
Vol 272 (2) ◽  
pp. 494-503 ◽  
Author(s):  
Massimo Caulo ◽  
Valentina Panara ◽  
Domenico Tortora ◽  
Peter A. Mattei ◽  
Chiara Briganti ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Imaging Study ◽  
Data Driven ◽  
Brain Gliomas
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