Department of Radiology.
AJNR Am J Neuroradiol. 2013 Sep;34(9):1836-40. doi: 10.3174/ajnr.A3510. Epub 2013 Apr 4.
In an effort to reduce radiation exposure in children requiring regular follow up for shunted hydrocephalus, our institution implemented a rapid brain MR imaging protocol. The purpose of this study was to review an academic practice experience with pediatric rapid brain MR imaging without patient sedation in the evaluation of hydrocephalus and a limited group of other conditions.
We retrospectively analyzed limited-sequence, rapid brain MR imaging scans performed in nonsedated patients younger than 14 years between April 2009 and December 2011. So-called failed examinations were determined by consensus of 2 authors as insufficiently diagnostic for evaluation of ventricular size. CT and MR imaging quarterly volumes for hydrocephalus-related indications were determined from 2005-2012. Multivariable logistic regression analysis was performed to elucidate factors potentially affecting scan durations including examination indication and patient age, sex, inpatient status, and clinical conditions.
A total of 398 examinations were performed on 168 patients (103 boys, 65 girls; median age, 13 months). None were deemed to be failed examinations. Median scan duration was 4.43 minutes (interquartile range, 4.42 minutes-5.88 minutes; SD, 2.42 minutes). Examination indication of altered mental status was the only factor associated with increased scan duration (+1.77 minutes; P = .0021). Hydrocephalus-related imaging volumes approximately doubled in the 7 years reviewed, but rapid MR imaging introduced in 2009 is quickly replacing CT scanning for these indications, accounting for nearly 7 of every 8 examinations at the end of the study period.
In every case of initial work-up and follow-up, rapid brain MR imaging effectively evaluated ventricular size and/or intracranial fluid and represents a viable alternative to CT scanning, irrespective of a child's age or clinical condition. For this indication and patient group, MR imaging is now the predominant imaging method in our practice.
为了降低需要定期随访分流脑积水儿童的辐射暴露，我们机构实施了快速脑部磁共振成像（MR）方案。本研究的目的是回顾性分析在不进行镇静的情况下，对脑积水和一组其他有限疾病进行儿科快速脑部 MR 成像的学术实践经验。
我们对 2009 年 4 月至 2011 年 12 月期间，年龄小于 14 岁的未镇静患者进行了有限序列快速脑部 MR 成像扫描。两名作者通过共识确定所谓的“失败检查”为诊断脑室大小评估不足。从 2005 年至 2012 年，确定了与脑积水相关的适应证的 CT 和 MR 成像季度体积。多变量逻辑回归分析用于阐明可能影响扫描时间的因素，包括检查适应证和患者年龄、性别、住院状态和临床状况。
共对 168 例患者（103 名男性，65 名女性；中位年龄 13 个月）进行了 398 次检查。均未被视为失败检查。中位扫描时间为 4.43 分钟（四分位距 4.42 分钟-5.88 分钟；标准差 2.42 分钟）。意识状态改变的检查适应证是唯一与扫描时间延长相关的因素（延长 1.77 分钟；P =.0021）。在审查的 7 年中，与脑积水相关的影像学体积增加了近一倍，但在 2009 年引入的快速 MR 成像技术很快取代了 CT 扫描，在研究期末近 7/8 的检查都采用了这种方法。
在初始检查和随访的每个病例中，快速脑部 MR 成像都有效地评估了脑室大小和/或颅内液体，是 CT 扫描的可行替代方法，与儿童的年龄或临床状况无关。对于该适应证和患者群体，MR 成像现在是我们实践中的主要成像方法。
