High-Pitch Low-Dose Whole-Body Computed Tomography for the Assessment of Ventriculoperitoneal Shunts in a Pediatric Patient Model: An Experimental Ex Vivo Study in Rabbits.

Abstract

The aim of this study was to assess the diagnostic value of whole-body low-dose (LD) computed tomography (CT) for the detection of ventriculoperitoneal (VP) shunt complications in pediatric patients compared with radiographic shunt series (SS) in an ex vivo rabbit animal model. In the first step, 2 optimized LD-CT imaging protocols, with high pitch (pitch, 3.2), low tube voltages (70 kVp and 80 kVp), and using both filtered back projection and iterative reconstruction, were assessed on a 16-cm solid polymethylmethacrylate phantom regarding signal-to-noise ratio and radiation dose. Taking both radiation dose and signal-to-noise ratio into account, the LD-CT protocol (80 kVp; 4 mA; pitch, 3.2) was identified as most appropriate and therefore applied in this study.After identification of appropriate LD-CT protocol, 12 VP shunts were implanted in 6 rabbit cadavers (mean weight, 5.1 kg). Twenty-four mechanical complications (extracranial and extraperitoneal malpositioning, breakages, and disconnections) were induced in half of the VP shunts. Low-dose CT and conventional SS were acquired in standard fashion. Dose-area products (DAPs) for SS and LD-CT were collected; effective radiation doses for both SS and LD-CT were estimated using CT-Expo (v. 2.3.1.) and age-specific effective dose (ED) estimates. Qualitative scoring of diagnostic confidence on a 5-point Likert scale (1, very low diagnostic confidence; 5, excellent diagnostic confidence) and blinded readings of both SS and LD-CTs were performed. Among the 24 VP shunt complications, LD-CT yielded excellent sensitivity and specificity for the detection of VP shunt complications (sensitivity, 0.98; specificity, 1; 95% confidence interval, 0.92-1) with excellent interobserver agreement (κ = 0.90). Shunt series yielded good sensitivity and specificity (sensitivity, 0.75; specificity, 1; 95% confidence interval, 0.58-0.92) with moderate interobserver agreement (κ = 0.56). No false-positive findings were registered. Compared with SS, LD-CT yielded significantly lower ED and DAPs (ED, 0.039 vs 0.062 mSv; DAP, 20.5 vs 26.3; P < 0.05). In this experimental ex vivo pediatric patient model, LD-CT yields excellent sensitivity for the detection of VP shunt complications at higher diagnostic confidence and lower radiation exposure compared with SS.