Retrospective Review of Rapid Pediatric Brain MR Imaging at an Academic Institution Including Practice Trends and Factors Affecting Scan Times

Niederhauser, Blake D.; McDonald, Robert J.; Eckel, L. J.; Keating, Gesina F.; Broomall, Eileen; Wetjen, Nicholas M.; Diehn, Felix E.; Schwartz, Kara M.; Hunt, Christopher H.; Welker, Kirk M.; Kallmes, David F.

doi:10.3174/ajnr.a3510

Cited by 36 publications

(34 citation statements)

References 16 publications

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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%

“…Niederhauser et al reviewed rapid brain MRI examinations in non-sedated children and found adequate diagnostic visualization of ventricular size in nearly 400 examinations. 12 At Site 1, the estimated imaging time for noncontrast brain CT is 5 minutes with an actual examination time of 5-10 seconds versus the estimated imaging time of 3-5 minutes for QB-MRI with an examination time of 45 seconds per plane, using axial, sagittal, and coronal imaging planes. The vast majority of patients did not require moderate or deep sedation for either modality.…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

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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“…Six studies compared ultra-fast MRI techniques to conventional MRI techniques [13][14][15][16][17][18]; eight reviewed the clinical use of ultra-fast techniques [6][7][8][19][20][21][22][23]; one compared two ultrafast techniques [24]; one compared ultra-fast and standard MRI to CT [25]; and one compared ultra-fast MRI to CT [26]. Six studies compared techniques using oversampling of k-space to conventional MRI [9,[27][28][29][30][31]; and one compared an ultra-fast technique to a technique using oversampling of kspace [32].…”

Section: Study Characteristicsmentioning

confidence: 99%

Magnetic resonance imaging acquisition techniques intended to decrease movement artefact in paediatric brain imaging: a systematic review

Woodfield

Kealey

2015

Pediatr Radiol

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Attaining paediatric brain images of diagnostic quality can be difficult because of young age or neurological impairment. The use of anaesthesia to reduce movement in MRI increases clinical risk and cost, while CT, though faster, exposes children to potentially harmful ionising radiation. MRI acquisition techniques that aim to decrease movement artefact may allow diagnostic paediatric brain imaging without sedation or anaesthesia. We conducted a systematic review to establish the evidence base for ultra-fast sequences and sequences using oversampling of k-space in paediatric brain MR imaging. Techniques were assessed for imaging time, occurrence of movement artefact, the need for sedation, and either image quality or diagnostic accuracy. We identified 24 relevant studies. We found that ultra-fast techniques had shorter imaging acquisition times compared to standard MRI. Techniques using oversampling of k-space required equal or longer imaging times than standard MRI. Both ultra-fast sequences and those using oversampling of k-space reduced movement artefact compared with standard MRI in unsedated children. Assessment of overall diagnostic accuracy was difficult because of the heterogeneous patient populations, imaging indications, and reporting methods of the studies. In children with shunt-treated hydrocephalus there is evidence that ultra-fast MRI is sufficient for the assessment of ventricular size.

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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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Retrospective Review of Rapid Pediatric Brain MR Imaging at an Academic Institution Including Practice Trends and Factors Affecting Scan Times

Cited by 36 publications

References 16 publications

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

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

Magnetic resonance imaging acquisition techniques intended to decrease movement artefact in paediatric brain imaging: a systematic review

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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