Does sevoflurane sedation in pediatric patients lead to "pseudo" leptomeningeal enhancement in the brain on 3 Tesla magnetic resonance imaging?

IF 1.4 Q3 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING World journal of radiology Pub Date : 2023-04-28 DOI:10.4329/wjr.v15.i4.127

Kiran Hilal, Kumail Khandwala, Saima Rashid, Faheemullah Khan, Shayan Sirat Maheen Anwar

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Abstract

Background: Prominent leptomeningeal contrast enhancement (LMCE) in the brain is observed in some pediatric patients during sedation for imaging. However, based on clinical history and cerebrospinal fluid analysis, the patients are not acutely ill and do not exhibit meningeal signs. Our study determined whether sevoflurane inhalation in pediatric patients led to this pattern of 'pseudo' LMCE (pLMCE) on 3 Tesla magnetic resonance imaging (MRI).

Aim: To highlight the significance of pLMCE in pediatric patients undergoing enhanced brain MRI under sedation to avoid misinterpretation in reports.

Methods: A retrospective cross-sectional evaluation of pediatric patients between 0-8 years of age was conducted. The patients underwent enhanced brain MRI under inhaled sevoflurane. The LMCE grade was determined by two radiologists, and interobserver variability of the grade was calculated using Cohen's kappa. The LMCE grade was correlated with duration of sedation, age and weight using the Spearman rho rank correlation.

Results: A total of 63 patients were included. Fourteen (22.2%) cases showed mild LMCE, 48 (76.1%) cases showed moderate LMCE, and 1 case (1.6%) showed severe LMCE. We found substantial agreement between the two radiologists in detection of pLMCE on post-contrast T1 imaging (kappa value = 0.61; P < 0.001). Additionally, we found statistically significant inverse and moderate correlations between patient weight and age. There was no correlation between duration of sedation and pLMCE.

Conclusion: pLMCE is relatively common on post-contrast spin echo T1-weighted MRI of pediatric patients sedated by sevoflurane due to their fragile and immature vasculature. It should not be misinterpreted for meningeal pathology. Knowing pertinent clinical history of the child is an essential prerequisite to avoid radiological overcalling and the subsequent burden of additional investigations.

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儿童患者的七氟醚镇静是否会导致3特斯拉磁共振成像中大脑中的“伪”软脑膜增强？

背景：在一些儿童患者镇静成像期间，观察到大脑中明显的软脑膜对比增强（LMCE）。然而，根据临床病史和脑脊液分析，这些患者没有急性疾病，也没有出现脑膜症状。我们的研究确定了儿童患者吸入七氟醚是否导致3特斯拉磁共振成像（MRI）上的这种“伪”LMCE（pLMCE）模式。目的：强调pLMCE在儿童患者在镇静状态下接受增强脑MRI检查中的意义，以避免报告中的误解。方法：对0-8岁的儿科患者进行回顾性横断面评估。患者在吸入七氟醚的情况下接受了增强的脑部MRI检查。LMCE等级由两名放射科医生确定，并使用Cohen’s kappa计算等级的观察者间变异性。LMCE等级与镇静持续时间、年龄和体重使用Spearman rho秩相关。结果：共纳入63例患者。14例（22.2%）表现为轻度LMCE，48例（76.1%）表现为中度LMCE，1例（1.6%）表现为重度LMCE。我们发现两位放射科医生在对比后T1成像中检测pLMCE方面基本一致（kappa值=0.61；P<0.001）。此外，我们发现患者体重和年龄之间存在统计学上显著的负相关和中度相关性。镇静持续时间与pLMCE之间没有相关性。结论：pLMCE在七氟烷镇静儿童患者的对比后自旋回波T1加权MRI上相对常见，因为他们的血管系统脆弱且不成熟。不应将其误解为脑膜病理。了解儿童的相关临床病史是避免放射学过度呼叫和随后额外调查负担的重要先决条件。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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World journal of radiology RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-

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