TY - JOUR T1 - <strong>CSF Shunt Scintigraphy - spills and stops, review of protocols via challenging cases</strong> JF - Journal of Nuclear Medicine JO - J Nucl Med SP - 2651 LP - 2651 VL - 63 IS - supplement 2 AU - Akash Sharma AU - Fatemeh Ataei AU - Ephraim Parent Y1 - 2022/06/01 UR - http://jnm.snmjournals.org/content/63/supplement_2/2651.abstract N2 - 2651 Introduction: Cerebrospinal fluid (CSF) shunt scintigraphy is a well-established though uncommonly used nuclear medicine procedure. In patients who have undergone any forms of a CSF shunt placement, any subsequent related symptoms such as worsening headaches are evaluated with a radiographic shunt evalation, non-contrast head CT, and a nuclear medicine evaluation. While the scintigraphic evaluation is known, some aspects of challenging cases are not well established, e.g. provocative manuevers for when the normal is not seen, duration of delayed imaging, role of SPECT-CT etc. We aim to present our experience, supplemented by published literature, to offer some solutions for challenging cases in CSF shunt scintigraphy.Methods: Using a molecular imaging data registry, under IRB approval, cases at our institution over last 10 years were reviewed and cataloged. Cases were selected to show the spectrum of possibilities from normal patency, delayed tracer movement, to obstruction. Inclusion criteria also focused on cases involving delayed images and documentation of provocative maneuvers.Results: We aim to highlight the common provocative maneuvers that can be performed if CSF flow is slow in the shunt. This is done in conjunction with a discussion of length of imaging, including when and how often delayed imaging may be performed. We also aim to highlight the value of SPECT-CT imaging as a problem solving tool. We will show select images of challenging cases, along with presenting symptoms and post-imaging management to demonstrate the value of shunt scintigraphy.Conclusions: CSF shunt scintigraphy remains a valuable procedure in evaluation of patients who have had a shunt placement. Understanding the details of the shunt, assessing the anatomic integrity prior to scintigraphy, and a consistent approach in using provocative manuevers and hybrid imaging may help practitioners perform this uncommon exam with skill.References:1. Infrequently Performed Studies in Nuclear Medicine: Part 2 Anita MacDonald and Steven Burrell. Journal of Nuclear Medicine Technology March 2009, 37 (1) 1-13; DOI: https://doi.org/10.2967/jnmt.108.0578512. Assessment Lumboperitoneal or Ventriculoperitoneal Shunt Patency by Radionuclide Technique: A Review Experience Cases. Sunanta Chiewvit et al. World J Nucl Med. 2014 May-Aug; 13(2): 75–84. ER -