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High School Student with a Traditionally Underrepresented Background

HS Poster

Poster 7 - ADVERSE IMPACT OF MAGNETIC RESONANCE IMAGING (MRI) ON SHUNTS

Saturday, October 26, 2024
10:00 AM - 12:00 PM EST
Location: Exhibit Hall E, F & G

Introduction: Hydrocephalus is a serious neurological condition caused by the abnormal accumulation of cerebrospinal fluid in the brain's ventricles. CSF plays a critical role in protecting the brain and spinal cord, providing nutrients, and maintaining homeostasis. Normally body makes just enough CSF each day and absorbs that same amount. However, when CSF is overproduced, or its absorption is impaired, the resulting pressure can damage brain tissues, leading to cognitive and physical impairments, and if left untreated, can be fatal. Ventriculoperitoneal shunts are the most common method for managing hydrocephalus, as they help drain excess CSF from the brain to the abdomen. However, these shunts are highly sensitive to magnetic fields, which poses a significant risk when patients undergo MRI. MRI scanners produce strong magnetic fields that can inadvertently alter the settings of magnetically controlled valves within the shunts. This study analyzes adverse events from FDA’s MAUDE database, focusing on cases where MRIs were implicated in shunt malfunction. The findings reveal that in 42% of these cases, patients experienced a significant worsening of their condition post-MRI, indicating that shunt may have been compromised by MRI exposure. This includes unintended changes to shunt settings, shunt malfunction, and new neurological symptoms. These results underscore need for enhanced shunt designs that are more resilient to magnetic fields, for revised MRI protocols that minimize risk of adverse effects on patients with shunts, and advocate for the development of MRI-compatible shunts and the refinement of clinical practices to ensure the safety and well-being of patients with hydrocephalus.

Materials and

Methods: We examined the adverse impacts of MRI procedures on ventriculoperitoneal (VP) shunts by analyzing data from FDA's Manufacturer and User Facility Device Experience (MAUDE) database. The study targeted records associated with the "JXG" code, which represents central nervous system-related components. Data spanning from January 2013 to December 2022 was extracted quarterly, resulting in 12,053 records. These records were consolidated into a single dataset, with additional columns added to ensure traceability, including event and report dates.

To identify relevant cases, we developed an MRI Indicator, a formula-driven field that flagged records containing the keyword "MRI" within the event narrative. This process reduced the dataset to 632 records where MRIs were implicated. Further analysis revealed that in 270 of these cases, adverse events were directly linked to MRI procedures. The adverse consequences were categorized into mutually exclusive types based on their nature.

This approach allowed us to quantify and categorize the different types of adverse events caused by MRIs, providing valuable insights into the risks associated with MRI procedures for patients with VP shunts. Our research highlights the importance of careful clinical practices and suggests the need for improved shunt designs to mitigate the risks posed by MRIs. This research paper underscores the potential dangers of MRIs for patients with VP shunts and calls for further investigation into alternative imaging methods or device enhancements to ensure patient safety.

Results, Conclusions, and Discussions: Our research investigated 632 cases where MRIs were associated with adverse events in patients with ventriculoperitoneal (VP) shunts. We discovered that in 42% of these cases, patients’ condition worsened post-MRI. The study identified that the primary cause of these adverse events was unintended changes in shunt settings due to the strong magnetic fields generated by MRIs. These changes can lead to serious complications, such as over-drainage or under-drainage of cerebrospinal fluid (CSF), potentially causing conditions like brain hemorrhage, increased intracranial pressure, and a recurrence of hydrocephalus symptoms. Additionally, the study reported that 11% of the cases involved central nervous system (CNS) symptoms, including headaches, nausea, confusion, and even unconsciousness. Valve malfunctions were observed in 10% of cases, where the valve either ceased functioning, shifted from its position, or was damaged beyond repair. About 8% patients experienced extreme outcomes, including ventricle splits and severe neurological events.
The research highlights the ongoing risk MRIs pose to shunt patients, evidenced by the consistent yearly incidence of MRI-related adverse events over the past decade. The study suggests that the role of MRIs in these adverse outcomes may be underappreciated by clinicians and calls for a reevaluation of current shunt technologies and clinical protocols. The FDA's recommendations on limiting electromagnetic exposure for shunt patients are affirmed by the findings, but the study highlights the need for more robust solutions.
To mitigate these risks, our research advocates for developing MRI-compatible shunts or alternative imaging modalities that do not compromise shunt integrity. Additionally, the study calls for better awareness and education among healthcare providers and patients about the potential dangers of MRI exposure in individuals with shunts. This could include more stringent post-MRI protocols to closely monitor shunt functionality and patient symptoms.
In conclusion, while MRIs are invaluable for diagnosing and managing various medical conditions, their impact on shunt functionality cannot be overlooked. The findings from our research underscore the critical need for advancements in shunt technology and clinical practices to ensure patient safety during MRI procedures. Addressing these challenges will help protect patients with shunts from the potentially severe consequences of MRI-related complications.

Acknowledgements (Optional): I want to express my deepest gratitude to my guide Dr. Sujata Bhatia for teaching me and coaching me throughout my research paper.

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