Use of fast-sequence spine MRI in pediatric patients

Abstract

OBJECTIVEThe 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.METHODSAfter 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.RESULTSA 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.CONCLUSIONSThe 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.

Elective one-minute full brain multi-contrast MRI versus brain CT in pediatric patients: a prospective feasibility study

“…Included patients in this study had a non-acute headache as the primary neurological manifestation, with a minority of cases presenting nausea/vomiting, dizziness, and syncope. Similarly, previous radiological studies on pediatric patients reported headache [ 15 , 17 , 19 – 21 , 23 ], vomiting [ 15 , 19 – 21 ], and syncope [ 19 , 21 ], but also altered mental status [ 15 , 17 , 19 ], seizures [ 15 , 17 , 19 – 21 ], and pain [ 15 ].…”

“…Despite the scheduling of clinical CT examinations after two weeks from referral, the clinical question in a majority of patients, as stated in the referral, was “brain tumor?”. Previous studies have investigated the clinical feasibility of fast MRI methods in pediatric patients with hydrocephalus [ 15 , 16 ], acute arterial ischemic stroke [ 17 ], traumatic brain injury [ 18 ], and non-traumatic pediatric emergency [ 19 ], while others have evaluated the diagnostic image quality of fast brain MRI [ 20 – 22 ] and fast spine MRI [ 23 ]. In accordance with the results from these previous studies, EPIMix performed well in a clinical situation, showing comparable diagnostic performance to CT in pediatric patients.…”

“…An advantage compared to some of the previous retrospective studies [ 15 – 17 , 19 , 21 , 23 ] is the prospective design of the present work. Further advantages of EPIMix compared to previous studies is the acquisition of a higher number of tissue contrasts, as opposed to only T2-weighted [ 15 , 22 ], T2 + T2* [ 18 ], T2 + T1 [ 23 ], and T2 + DWI [ 17 ]. Further, EPIMix has a shorter acquisition time than most previous studies with scan times ranging from 2 up to 22 min [ 15 , 17 – 20 , 22 , 23 ].…”

“…Further advantages of EPIMix compared to previous studies is the acquisition of a higher number of tissue contrasts, as opposed to only T2-weighted [ 15 , 22 ], T2 + T2* [ 18 ], T2 + T1 [ 23 ], and T2 + DWI [ 17 ]. Further, EPIMix has a shorter acquisition time than most previous studies with scan times ranging from 2 up to 22 min [ 15 , 17 – 20 , 22 , 23 ]. Also, comparing EPIMix to CT is important since it might obviate the need for a CT if a short MRI scan can answer the clinical question with similar diagnostic performance.…”

Shortened total spine MRI protocol in the detection of spinal cord compression and pathology for emergent settings: a noninferiority study

“…T2 SPACE and HASTE techniques are appealing techniques for abbreviated spine protocols since they can be acquired in the lumbar spine in as little as 3 min for SPACE and much less than a minute for HASTE [26,30]. However, while most reports using T2 SPACE sequences show similar sensitivities and specificities in the detection of degenerative changes in the lumbar spine between rapid and full lumbar spine protocols, it has been previously noted that T2 SPACE sequences may not well evaluate soft tissue and cord lesions [28].…”