Background: The assessment of the functionality of intrathecal drug delivery (IDD) systems
remains difficult and time-consuming. Catheter-related problems are still very common, and
sometimes difficult to diagnose.
Objectives: The aim of the present study is to investigate the accuracy of high-resolution
three-dimensional computed tomography (CT) in order to detect catheter-related pump
dysfunction.
Study Design: An observational, retrospective investigation.
Setting: Academic medical center in Germany.
Methods: We used high-resolution three dimensional (3D) computed tomography with
volume rendering technique (VRT) or fluoroscopy and conventional axial-CT to assess IDDrelated complications in 51 patients from our institution who had IDD systems implanted for
the treatment of chronic pain or spasticity.
Results: Twelve patients (23.5%) presented a total of 22 complications. The main type of
complication in our series was catheter-related (50%), followed by pump failure, infection, and
inappropriate refilling. Fluoroscopy and conventional CT were used in 12 cases. High-resolution
3D CT VRT scan was used in 35 instances with suspected yet unclear complications.
Using 3D-CT (VRT) the sensitivity was 58.93% – 100% (CI 95%) and the specificity 87.54% –
100% (CI 95%).The positive predictive value was 58.93% – 100% (CI 95%) and the negative
predictive value: 87.54% – 100% (CI 95%).
Fluoroscopy and axial CT as a combined diagnostic tool had a sensitivity of 8.3% – 91.7% (CI
95%) and a specificity of 62.9% – 100% (CI 95%). The positive predictive value was 19.29% –
100% (CI 95%) and the negative predictive value: 44.43% – 96.89% (CI 95%).
Limitations: This study is limited by its observational design and the small number of cases.
Conclusion: High-resolution 3D CT VRT is a non- invasive method that can identify IDDrelated complications with more precision than axial CT and fluoroscopy.
Key words: Volume rendering technique (VRT), intrathecal drug delivery systems, highresolution 3D computed tomography, complications, spasticity, chronic pain, cost effectiveness,
fluoroscopy