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Rapid sequence magnetic resonance imaging in the assessment of children with hydrocephalus
Brent R O'Neill1, Sumit Pruthi, Harmanjeet Bains
1Division of Pediatric Neurosurgery, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA.
Objective:
Recent reports have shown the utility of rapid-acquisition magnetic resonance imaging (MRI) in the evaluation of children with hydrocephalus. Rapid sequence MRI (RS-MRI) acquires clinically useful images in seconds without exposing children to the risks of ionizing radiation or sedation. We review our experience with RS-MRI in children with shunts.
Methods:
Overall image quality, cost, catheter visualization, motion artifact, and ventricular size were reviewed for all RS-MRI studies obtained at Seattle Children's Hospital during a 2-year period. Image acquisition time was 12-19 seconds, with sessions usually lasting less than 3 minutes.
Results:
Image quality was very good or excellent in 94% of studies, whereas only one was graded as poor. Significant motion artifact was noted in 7%, whereas 77% had little or no motion artifact. Catheter visualization was good or excellent in 57%, poor in 36%, and misleading in 7%. Small ventricular size was correlated with poor catheter visualization (Spearman's ρ = 0.586; P < 0.00001). RS-MRI imaging cost ∼$650 more than conventional computed tomography (CT).
Conclusions:
Our study supports that RS-MRI is an adequate substitute that allows reduced use of CT imaging and resultant exposure to ionizing radiation. Catheter position visualization remains suboptimal when ventricles are small, but shunt malfunction can be adequately determined in most cases. The cost is significantly more than CT, but the potential for lifetime reduction in radiation exposure may justify this expense in children. Limitations include the risk of valve malfunction after repeated exposure to high magnetic fields and the need for reprogramming with many types of adjustable valves.
Insights
Rapid sequence MRI (RS-MRI) offers a safe, effective alternative to CT scans for evaluating pediatric hydrocephalus and shunts. While more expensive, RS-MRI significantly reduces radiation exposure in children.
Area of Science:
- Medical Imaging
- Pediatric Radiology
- Neurosurgery
Background:
- Hydrocephalus in children often requires monitoring of shunt function.
- Conventional imaging methods like CT scans involve ionizing radiation.
- Rapid-acquisition MRI (RS-MRI) has emerged as a potentially safer alternative.
Purpose of the Study:
- To review the utility and outcomes of RS-MRI in evaluating children with hydrocephalus and shunts.
- To assess image quality, cost-effectiveness, and diagnostic accuracy compared to traditional methods.
Main Methods:
- A retrospective review of RS-MRI studies in children with shunts over a 2-year period.
- Evaluation of image quality, catheter visualization, motion artifact, and ventricular size.
- Comparison of RS-MRI costs with conventional CT imaging.
Main Results:
- 94% of RS-MRI studies demonstrated very good or excellent image quality.
- Catheter visualization was good/excellent in 57% but suboptimal in small ventricles.
- RS-MRI is more expensive than CT but significantly reduces radiation exposure.
Conclusions:
- RS-MRI is an adequate substitute for CT in evaluating pediatric hydrocephalus and shunts, reducing radiation exposure.
- While catheter visualization can be challenging in small ventricles, shunt malfunction is generally detectable.
- The higher cost of RS-MRI may be justified by the long-term benefit of reduced radiation exposure in children.
