Should I irradiate with computed tomography or sedate for magnetic resonance imaging?

Abstract

In the context of pediatric cross-sectional imaging, the risk of ionizing radiation for CT and the potential adverse effects associated with sedation/anesthesia for MRI continue to provoke lively discussions in the pediatric literature and lay press. This is particularly true for issues relating to the risks of ionizing radiation for CT, which has been a topic of discussion for nearly two decades. In addition to understanding these potential risks and the importance of minimizing individual pediatric patient exposure to ionizing radiation, it is equally important for radiologists to be able to frame these risks with respect to the potential for adverse outcomes associated with the use of anesthesia for cross-sectional imaging in the pediatric population. Notably, before such risks can be estimated and compared, one should always consider the potential utility of each imaging modality for a given diagnosis. If one cross-sectional imaging modality is likely to be far superior to the other for a specific clinical question, every effort must be made to safely image the child, even if sedation/anesthesia is required.

Magnetic resonance imaging findings in pediatric neck infections—a comparison with adult patients

“…In the literature, a lively debate and expert opinions have been published for and against the use of CT and MRI in the pediatric population, and the argumentation is evolving [19].…”

“…In the literature, a lively debate and expert opinions have been published for and against the use of CT and MRI in the pediatric population, and the argumentation is evolving [ 19 ]. In short, the scientific conversation focuses on weighing up the potential harm of radiation and the possible immediate or long-term harm related to anesthesia.…”

MRI of acute neck infections: evidence summary and pictorial review

“…Because many younger children require sedation or anesthesia for MRI, choosing an appropriate emergency imaging method for a suspected neck infection is a balance between the potential harm of radiation and the possible immediate or long-term harm related to anesthesia [ 30 ]. About a third of children required sedation with spontaneous breathing, whereas the minority required general anesthesia and intubation [ 8 ].…”

Imaging Recommendations for Diagnosis, Staging, and Management of Pediatric Solid Tumors

“…However, sedation risk should be considered against radiation risk and CT scan can be performed for cases with contraindication to MRI or difficult anesthesia or no availability. 7 MRI field strength of 1.5 to 3 T and acquisition with the smallest suitable coil (e.g., head coil or flexible phased-array body coil) is recommended with breath holding and gated sequences. Study may be performed under sedation or general anesthesia if needed, depending on the age and weight of child.…”