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Published on: January 27, 2011
Pseudo-Leptomeningeal Contrast Enhancement at 3T in Pediatric Patients Sedated by Propofol
A M McKinney1, A Chacko Achanaril2, B Knoll3
1From the Department of Radiology (A.M.M., A.C.A., D.R.N.), Neuroradiology Division, University of Minnesota, Minneapolis, Minnesota mckinrad@umn.edu.
Insights
Propofol sedation can cause leptomeningeal contrast enhancement in young children during MRI. This enhancement is more common with spin-echo T1WI sequences and is not indicative of disease.
Area of Science:
- Neuroradiology
- Pediatric Imaging
- Pharmacology
Background:
- Propofol is a sedative that affects cerebral perfusion by reducing oxygen metabolism.
- Young children frequently receive intravenous sedation for Magnetic Resonance (MR) imaging procedures.
- Understanding contrast enhancement patterns in pediatric MR imaging is crucial for accurate diagnosis.
Purpose of the Study:
- To evaluate the degree of leptomeningeal contrast enhancement on 3T postcontrast brain MR imaging in children sedated with propofol.
- To determine if this enhancement correlates with imaging sequence, sedation dosage, or patient demographics (age, weight).
Main Methods:
- A retrospective review of 43 children (1-5 years) who underwent 3T postcontrast brain MR imaging with propofol sedation.
- Contrast enhancement was assessed using gradient-echo T1-weighted imaging (T1WI) and spin-echo T1WI sequences.
- Three neuroradiologists graded enhancement, and interobserver reliability was calculated.
Main Results:
- Leptomeningeal contrast enhancement was significantly greater on spin-echo T1WI compared to gradient-echo T1WI (P < .0001).
- Enhancement showed a moderate inverse correlation with patient age and weight (P = .003-.032).
- Sedation dosage, duration, and timing of contrast administration did not correlate with enhancement (P > .05).
Conclusions:
- Leptomeningeal contrast enhancement is more frequent and pronounced on 3T spin-echo T1WI in propofol-sedated children.
- This finding, termed "pseudo"-leptomeningeal enhancement, should not be misdiagnosed as pathology.
- The phenomenon may be linked to propofol-induced vasodilation and is more prominent in younger/smaller children.
Background And Purpose:
Propofol is a cerebral vasoconstrictor that modulates cerebral perfusion by decreasing the metabolic rate of oxygen. Because younger children often undergo intravenous sedation for MR imaging, this study set out to evaluate the degree of leptomeningeal contrast enhancement on 3T postcontrast brain MR imaging and to determine whether this phenomenon relates to sequence, sedation dosage, or patient age or weight.
Materials And Methods:
During a 2-year period, of 152 children 1-5 years of age who underwent MR imaging, 43 were included for MRI review. Of these, 37 underwent postcontrast imaging with either solely gradient-echo T1WI (n = 20) or spin-echo T1WI (n = 17); notably, 6 patients underwent both sequences. Three neuroradiologists separately graded the degree of leptomeningeal contrast enhancement (grades 0-3) that was correlated with various factors and calculated the interobserver reliability.
Results:
For the 43 patients, the mean patient age was 3.1 ± 1.4 years. The leptomeningeal contrast-enhancement grade was significantly greater (P < .0001) on spin-echo T1WI (1.9-2.1) versus gradient-echo TIWI (1.2-1.4). Patient weight (r = -0.366 to -.418, P = .003-.01) and age (r = -0.315 to -0.418, P = .004-.032) moderately and inversely correlated with the leptomeningeal contrast-enhancement grade, while the propofol dosage, sedation duration, and time to T1WI post-contrast administration did not (each, P > .05). The interobserver κ was strong regarding the leptomeningeal contrast-enhancement grade on both spin-echo T1WI (κ = 0.609-0.693, P < .0001) and gradient-echo TIWI (κ = 0.567-0.698, P < .0001).
Conclusions:
Leptomeningeal contrast enhancement (or "pseudo"-leptomeningeal contrast enhancement) occurs with a greater frequency and degree on 3T postcontrast spin-echo T1WI relative to gradient-echo TIWI in younger children sedated with propofol and should not be mistaken for disease. This phenomenon may be more prominent with lower age or size and may arise from propofol-induced vascular smooth-muscle dilation.
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