Purpose or Case Report: Shunt malfunction evaluation traditionally relied on radiographs and CT head scans, but the transition to MR imaging is imperative to minimize radiation exposure. In this context, we aim to revisit the signs of variation of intracranial pressure changes on MRI in a clinical setting of suspected shunt malfunction.
Methods & Materials: We conducted a retrospective review of our teaching database at a tertiary care pediatric hospital with dedicated pediatric neuroradiology and pediatric neurosurgery services collecting various imaging findings of shunt malfunction and display it as a pictorial review.
Results: This pictorial review will display indicators associated with increased and decreased intracranial pressure related to acute shunt malfunction and over-drainage. These imaging findings encompass ventricular enlargement, periventricular cerebrospinal fluid leakage, narrowing of sulci, separation of sutures, blunting of the optic chiasmatic recess, deformation of the lamina terminalis, distension of the optic nerve sheath, papilledema, constriction of the Dural Venus sinus, intracranial and extracranial peri catheter CSF leaks. In addition, signs of excessive shunt drainage and intracranial hypotension will also be discussed. Furthermore, we will elaborate on the shunt adjustment methodologies we employ at our institution post-MRI assessment.
Conclusions: While both CT and MRI are useful for evaluating ventricular size in suspected shunt malfunction cases, limited MRI presents challenges in assessing shunt integrity and precise location. However, MRI offers valuable insights into shunt malfunction. As healthcare institutions nationwide transition to limited MRI for these evaluations, it is crucial to reacquaint ourselves with MRI features of shunt malfunction, enhancing patient care while minimizing radiation exposure.