Ventricular Shunt Radiographs: Still Relevant in the Cross-Sectional Era? Pictorial Review of the Radiographic Appearance of Ventricular Shunts and Approach to Interpreting Shunt Series Radiographs

In our experience, radiologists are becoming less confident and less comfortable interpreting shunt radiographs, likely a result of a shift in radiology residency training toward cross-sectional imaging. However, shunt series remain a relevant choice for the interrogation of shunt integrity due to the advantages of minimal radiation exposure, ready availability, and rapid examination times. Accurate radiographic diagnosis of shunt malfunction requires the following: 1) an understanding of the ventricular shunt components and their radiographic appearance, 2) a systematic approach to the interpretation of shunt series, and 3) knowledge of the common types and sites of shunt malfunction. The aim of this pictorial review was to outline our approach to shunt series and to provide radiologists with a compendium of illustrative radiographic examples of normal and abnormal ventricular shunts.

Learning Objective: To describe the radiographic appearance of different ventricular shunt types and differentiate them from shunt mimics, to understand common sites and mechanisms of shunt malfunction, to describe an approach to shunt series interpretation, and to understand the advantages and disadvantages of shunt series and other modalities used in the evaluation of suspected shunt malfunction.