Clinical utility of SPECT/CT radionuclide shuntgraphy in suspected ventriculoperitoneal shunt dysfunction

This study aims to develop and validate a more efficient diagnostic system for suspected ventriculoperitoneal shunt dysfunction by integrating traditional radionuclide shuntgraphy with SPECT imaging. This retrospective study examined patients with suspected shunt malfunction admitted to our neurosurgery department from 2021 to 2024, who underwent SPECT/CT imaging of the ventricular shunt. SPECT/CT results were categorized as three groups based on tracer behavior: normal shunt function, partial obstruction, and shunt obstruction. Baseline data, imaging characteristics and clinical management were recorded. Diagnostic agreement with surgery was analyzed only in patients who underwent revision, the only subgroup with a definitive intraoperative reference standard. A study of 46 SPECT/CT images from 42 patients found 14 normal shunt functions, 23 with partial obstruction, and 9 with complete obstruction. Nineteen patients underwent surgery, and SPECT/CT demonstrated good agreement with intraoperative findings (16/19), corresponding to a sensitivity of 88.9%. Specificity could not be reliably estimated because there were no true-negative surgical cases. Thin-slice CT scans assessing shunt catheter position and morphology revealed abnormalities such as malposition of the ventricular or abdominal catheter, tortuosity in the abdominal segment, and obstruction or rupture of the catheter body. Abnormal shunt tube positioning or morphology was more prevalent in the obstruction group ( p = 0.0083). In this heterogeneous clinical population, the SPECT/CT shunt imaging diagnostic system prove0d feasible and clinically informative.