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Note: Tc-99m DTPA is not specifically approved for intrathecal administration, and accordingly meets the phamacopoeial bacterial endotoxin standard for an intravenously administered drug. Because the CNS is more sensitive to endotoxins, only < 10% of the volume of a Tc- 99m DTPA vial should be injected for this study whenever the radiopharmaceutical is to be refluxed into the ventricular system. In this case, there was no intention to reflux tracer into the ventricles.
(2) The normal transit time is approximately 10-20 minutes. A transit time of more than 30 minutes is abnormal. Althought the proximal limb is not evaluated directly, if there is normal flow through the system then the proximal limb must be patent.
(3) Removal of fluid (e.g. for culture) is avoided, as it may decrease the pressure below that needed to open the shunt valve and may artifactually produce an abnormal test result.
(4) If no flow is seen, placing the patient in an erect position will slightly increase the forward pressure and encourage CSF flow.
References and General Discussion of CSF Shunt Scintigraphy (Anatomic field:Skull and Contents, Category:Organ specific)
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