Background: Intracranial hypertension secondary to shunt-failure is a feared complication requiring cross-sectional imaging for diagnosis. We compared dural sinus narrowing and ventriculomegaly as predictors of shunt-failure. Methods: 60 head MRIs and 60 MR venographies of hydrocephalus patients age 0-18 years (n=25) were analyzed. MRI studies were included when f/u clinical data combined with intra-operative findings proved shunt-failure (positive Gold standard) or when MRI was available when the child was well (negative Gold standard). The absence or presence of concerning hydrocephalus was diagnosed. On MRV, the major dural sinuses were independently analyzed with respect to >50% narrowing, suggesting compression by increased CSF pressure. Ventriculomegaly and significant dural sinus narrowing was correlated to the presence/absence of shunt failure as per Gold standard. Results: Sinus narrowing substantially correlated with proven shunt-failure (Cohen’s kappa test 0.635/p<=0.00001 as per Fisher exact test) while ventriculomegaly correlated poorly (0.258/p=0.0751). Sensitivity/specificity was 0.69/0.92 for sinus narrowing and 0.43/0.81 for ventriculomegaly. Conclusions: In this patient cohort, dural sinus narrowing more reliably predicted shunt-failure compared to ventriculomegaly.