Fast-brain MRI in children is quick, without sedation, and radiation-free, but beware of limitations

Rozovsky, Katya; Ventureyra, Enrique C. G.; Miller, Elka

doi:10.1016/j.jocn.2012.02.048

Cited by 58 publications

(49 citation statements)

References 14 publications

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“…14 Although it is of lower quality than traditional MRI, the resulting image sufficiently permits a reliable assessment of ventricle size within 60-90 seconds, even in an uncooperative patient. [15][16][17] Although test performance of rapid cranial MRI is unknown, these benefits have prompted some pediatric centers to adopt this modality for patients with ventricular shunts.…”

Section: Resultsmentioning

confidence: 99%

Comparison of Rapid Cranial MRI to CT for Ventricular Shunt Malfunction

Boyle¹,

Paldino

Kimia³

et al. 2014

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT: Rapid cranial MRI is a radiation-free method to assess children with possible ventricular shunt malfunction. However, the test performance of rapid cranial MRI has never been compared with that of cranial CT, the current reference standard. WHAT THIS STUDY ADDS:The accuracy of rapid cranial MRI was not inferior to that of CT for diagnosing ventricular shunt malfunction. Rapid cranial MRI is an important radiation-sparing diagnostic alternative for children presenting emergently with possible ventricular shunt malfunction. abstract OBJECTIVES: To compare the accuracy of rapid cranial magnetic resonance imaging (MRI) with that of computed tomography (CT) for diagnosing ventricular shunt malfunction. METHODS:We performed a single-center, retrospective cohort study of children #21 years of age who underwent either rapid cranial MRI or cranial CT in the emergency department (ED) for evaluation of possible ventricular shunt malfunction. Each neuroimaging study was classified as "normal" (unchanged or decreased ventricle size) or "abnormal" (increased ventricle size). We classified a patient as having a ventricular shunt malfunction if operative revision for relief of mechanical causes of altered shunt flow was needed within 72 hours of initial ED evaluation. Our primary analysis tested noninferiority of the accuracy of rapid cranial MRI to CT for diagnosing shunt malfunction (noninferiority margin 10%). RESULTS:We included 698 ED visits for 286 unique patients, with a median age at visit of 10.0 years (interquartile range 5.9-15.5 years). Patients underwent CT in 336 (48%) or rapid cranial MRI in 362 (52%) of ED visits for evaluation of possible shunt malfunction. Patients had operative revision for ventricular shunt malfunction in 140 ED visits (20%). The accuracy of rapid cranial MRI was not inferior to that of CT scan for diagnosing ventricular shunt malfunction (81.8% MRI vs 82.4% CT; risk difference 2.0%; 95% confidence interval, -4.2% to 8.2%).CONCLUSIONS: Rapid cranial MRI was not inferior to CT for diagnosing ventricular shunt malfunction and offers the advantage of sparing a child ionizing radiation exposure. Pediatrics 2014;134:e47-e54

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Section: Resultsmentioning

confidence: 99%

Comparison of Rapid Cranial MRI to CT for Ventricular Shunt Malfunction

Boyle¹,

Paldino

Kimia³

et al. 2014

Pediatrics

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“…In our study, the sensitivity and specificity of QB-MRI were not significantly different from that of CT for shunt evaluation. In earlier studies, Iskandar et al, 7 Ashley et al, 2 O'Neill et al, 13 Rozovsky et al, 15 and Niderhauser et al 12 reported on image quality, catheter visualization, and image acquisition time for QB-MRI for shunt-dependent hydrocephalus (also referred to as rapid-sequence MRI [RS-MRI] or rapid brain MRI). The acquisition time and procedure time for QB-MRI reported by prior studies are similar to ours.…”

Section: Discussionmentioning

confidence: 99%

Test characteristics of quick brain MRI for shunt evaluation in children: an alternative modality to avoid radiation

Yue¹,

Meckler

Fleischman

et al. 2015

PED

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OBJECT Quick brain magnetic resonance imaging (QB-MRI) is a rapid, radiation-free technique to detect life-threatening CSF shunt malfunction. QB-MRI has not been widely studied or adopted. The primary objective of this study was to evaluate the test characteristics of QB-MRI for detecting shunt malfunction. Test characteristics of brain computed tomography (CT) and QB-MRI were then compared. Secondary objectives included comparison of time to study completion and use of sedatives for both modalities, as well as comparison of time to study completion for QB-MRI before and after implementation of a Pediatric Emergency Department (PED) shunt clinical pathway. METHODS A retrospective chart review was performed at 2 tertiary care hospital PEDs. The authors reviewed the charts of children who underwent QB-MRI or CT for suspected shunt malfunction between July 2008 and June 2012. They also reviewed the patients' neuroradiology reports and classified ventricular size as positive (enlarged) or negative (normal, smaller, or unchanged). Shunt malfunction was defined by surgical revision within 30 days. RESULTS Nine hundred ninety-seven PED visits (involving 724 QB-MRIs and 273 CTs) were included. Surgical revision was performed in 235 cases (23.6%). For QB-MRI, sensitivity was 58.5% (95% CI 51.1%–65.6%) and specificity was 93.3% (90.8%–95.3%). For CT, sensitivity was 53.2% (95% CI 38.1%–67.9%) and specificity was 95.6% (92%–97.9%). The mean time to completion of QB-MRI was 115 minutes versus 83 minutes for CT (difference 32 minutes, 95% CI, 22–42 minutes, p < 0.001). The mean time from presentation to completion of QB-MRI prior to application of the CSF shunt pathway was 132 minutes versus 112 minutes after application of the CSF shunt pathway (difference 20 minutes, 95% CI 5–35 minutes, p = 0.01). Anxiolytic medications were used in 3.7% of CT studies and 4.4% of QB-MRI studies (p = 0.74). CONCLUSIONS QB-MRI and CT have similar test characteristics for detecting CSF shunt malfunction in children and similar requirements for sedation. The longer interval from order placement to imaging completion for QB-MRI is arguably justified by reduction of radiation exposure in this population subject to frequent brain imaging.

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“…11 Since then, UF-MR imaging has been validated with similar test characteristics for the evaluation of possible shunt failure (assessment of ventricular size and catheter visualization) compared with head CT. [17][18][19] Diagnostic image quality and the short image-acquisition time of UF-MR imaging have also been reported. [11][12][13][14][15] Despite the aforementioned publications, consistent nationwide use of this radiation-free neuroimaging technique has been somewhat limited. The palpable growing demand to improve quality and safety in imaging is now requiring radiologists to take leadership responsibilities, beyond simply reading a timely accurate radiology examination.…”

Section: Figmentioning

confidence: 99%

“…Ultrafast brain MR imaging (UF-MR imaging) offers reliable visualization of the ventricular catheter and superior anatomic detail of the ventricular system; therefore, diagnostic accuracy of the test is not reduced as the child benefits from radiation-free imaging. [11][12][13][14][15] However, in our experience, these MR imaging protocols are limited to relatively few centers or are performed only during certain hours of the day.…”

mentioning

confidence: 99%

How to Reduce Head CT Orders in Children with Hydrocephalus Using the Lean Six Sigma Methodology: Experience at a Major Quaternary Care Academic Children's Center

Tekes¹,

Jackson²,

Ogborn

et al. 2016

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Lean Six Sigma methodology is increasingly used to drive improvement in patient safety, quality of care, and cost-effectiveness throughout the US health care delivery system. To demonstrate our value as specialists, radiologists can combine lean methodologies along with imaging expertise to optimize imaging elements-of-care pathways. In this article, we describe a Lean Six Sigma project with the goal of reducing the relative use of pediatric head CTs in our population of patients with hydrocephalus by 50% within 6 months.

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Fast-brain MRI in children is quick, without sedation, and radiation-free, but beware of limitations

Cited by 58 publications

References 14 publications

Comparison of Rapid Cranial MRI to CT for Ventricular Shunt Malfunction

Comparison of Rapid Cranial MRI to CT for Ventricular Shunt Malfunction

Test characteristics of quick brain MRI for shunt evaluation in children: an alternative modality to avoid radiation

How to Reduce Head CT Orders in Children with Hydrocephalus Using the Lean Six Sigma Methodology: Experience at a Major Quaternary Care Academic Children's Center

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