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Whole-body PET/MRI of Pediatric Patients: The Details That Matter
Published on: December 19, 2017
Use of fast-sequence spine MRI in pediatric patients
Jordan I Gewirtz1, Alex Skidmore1, Matthew D Smyth1
11Department of Neurological Surgery and.
Insights
A new fast spine MRI protocol for children eliminates the need for sedation. This abbreviated 2-minute scan effectively identifies and monitors conditions like syrinx and spinal dysraphism in pediatric patients.
Area of Science:
- Pediatric Radiology
- Neuroimaging
- Medical Technology
Background:
- Pediatric spine MRI often requires sedation due to the inability of young children to remain still.
- Sedation in pediatric patients carries inherent risks and logistical challenges.
- Traditional MRI protocols can be lengthy, increasing the likelihood of motion artifact and the need for sedation.
Purpose of the Study:
- To develop and evaluate an abbreviated pediatric spine MRI protocol.
- To reduce or eliminate the need for sedation in young children undergoing spine MRI.
- To assess the efficacy of a fast MRI protocol for diagnosing and monitoring spinal conditions.
Main Methods:
- A retrospective review of 47 fast spine MRI scans in 45 pediatric patients (2017-2019).
- The protocol utilized T2-weighted half-Fourier acquisition single-shot turbo spin echo, T1-weighted turbo spin echo, and T2-weighted STIR sequences.
- Total acquisition time was 2 minutes, with individual sequences under 60 seconds; interpretability was assessed clinically and radiologically.
Main Results:
- No scans were uninterpretable or unusable; 8 scans had minor motion artifact limitations.
- The protocol was effective in identifying and monitoring syrinx (30 patients) and spinal dysraphism (22 patients).
- Seven patients had follow-up sedated MRIs within a year, confirming findings from the fast protocol without new discoveries.
Conclusions:
- The fast spine MRI protocol is the first reported series for pediatric use, successfully avoiding sedation.
- This abbreviated protocol is capable of identifying and monitoring key intraspinal anomalies in young patients.
- The findings suggest a viable alternative to standard MRI protocols, improving patient safety and workflow.
Objective:
The immediate and long-term risk of anesthesia in the pediatric population is controversial. Traditional spine MRI protocols require the patient to remain still during the examination, and in young children this frequently results in the need for sedation administration. The authors' goal was to develop an abbreviated spine MRI protocol to reduce sedation administration in young patients undergoing spine MRI.
Methods:
After IRB approval, the medical records of all pediatric patients who underwent a fast spine MRI protocol between 2017 and 2019 were reviewed. The protocol consisted of T2-weighted half-Fourier acquisition single-shot turbo spin echo, T1-weighted turbo spin echo, and T2-weighted STIR sequences acquired in the sagittal plane. The total acquisition time was 2 minutes with no single sequence acquisition longer than 60 seconds. Interpretability of the scans was assessed in accordance with the radiology report in conjunction with the neurosurgeon's clinical notes.
Results:
A total of 47 fast spine MRI sessions were performed in 45 patients. The median age at the time of the MRI was 2.4 years (25th-75th quartile, 1.1-4.3 years; range 0.16-18.58 years). The most common indication for imaging was to rule out or follow a known syrinx (n = 30), followed by the need to rule out or follow known spinal dysraphism (n = 22). There were no uninterpretable or unusable scans. Eight of 47 scans were noted to have moderate motion artifact limitations with respect to the quality of the scan. Seven patients underwent a subsequent MRI with a sedated standard spine protocol within 1 year from the fast scan, which confirmed the findings on the fast MRI protocol with no new findings identified.
Conclusions:
The authors report the first pediatric series of a fast spine MRI protocol for use in young patients. The protocol does not require sedation and is able to identify and monitor syrinx, spinal dysraphism, and potentially other intraspinal anomalies.
