钆基造影剂在儿童急诊首发痫性发作初始评估中的应用。
Utility of Gadolinium-Based Contrast in Initial Evaluation of Seizures in Children Presenting Emergently.
机构信息
From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut.
From the Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut
出版信息
AJNR Am J Neuroradiol. 2023 Oct;44(10):1208-1211. doi: 10.3174/ajnr.A7976. Epub 2023 Aug 31.
BACKGROUND AND PURPOSE
The frequency and utility of gadolinium in evaluation of acute pediatric seizure presentation is not well known. The purpose of this study was to assess the utility of gadolinium-based contrast agents in MR imaging performed for the evaluation of acute pediatric seizure presentation.
MATERIALS AND METHODS
We identified consecutive pediatric patients with new-onset seizures from October 1, 2016, to September 30, 2021, who presented to the emergency department and/or were admitted to the inpatient unit and had an MR imaging of the brain for the evaluation of seizures. The clinical and imaging data were recorded, including the patient's age and sex, the use of IV gadolinium, and the underlying cause of epilepsy when available.
RESULTS
A total of 1884 patients were identified for inclusion. Five hundred twenty-four (28%) patients had potential epileptogenic findings on brain MR imaging, while 1153 (61%) patients had studies with normal findings and 207 (11%) patients had nonspecific signal changes. Epileptogenic findings were subclassified as the following: neurodevelopmental lesions, 142 (27%); intracranial hemorrhage (traumatic or germinal matrix), 89 (17%); ischemic/hypoxic, 62 (12%); hippocampal sclerosis, 44 (8%); neoplastic, 38 (7%); immune/infectious, 20 (4%); phakomatoses, 19 (4%); vascular anomalies, 17 (3%); metabolic, 3 (<1%); and other, 90 (17%). Eight hundred seventy-four (46%) patients received IV gadolinium. Of those, only 48 (5%) cases were retrospectively deemed to have necessitated the use of IV gadolinium: Fifteen of 48 (31%) cases were subclassified as immune/infectious, while 33 (69%) were neoplastic. Of the 1010 patients with an initial noncontrast study, 15 (1.5%) required repeat MR imaging with IV contrast to further evaluate the findings.
CONCLUSIONS
Gadolinium contrast is of limited additive benefit in the imaging of patients with an acute onset of pediatric seizures in most instances.
背景与目的
在评估急性儿科癫痫发作表现时，钆剂的使用频率和效用尚不清楚。本研究旨在评估基于钆的对比剂在用于评估急性儿科癫痫发作表现的磁共振成像中的效用。
材料与方法
我们从 2016 年 10 月 1 日至 2021 年 9 月 30 日期间，连续纳入新发病例的儿科患者，这些患者在急诊科就诊和/或住院，并进行了脑部磁共振成像以评估癫痫发作。记录了患者的年龄和性别、是否使用 IV 钆剂以及在有条件的情况下癫痫的潜在病因等临床和影像学数据。
结果
共纳入 1884 例患者。524 例（28%）患者脑部磁共振成像有潜在的致痫病灶，1153 例（61%）患者检查结果正常，207 例（11%）患者信号改变不特异。致痫病灶分为以下几类：神经发育病变 142 例（27%）；颅内出血（创伤性或脑室内）89 例（17%）；缺血/缺氧性 62 例（12%）；海马硬化 44 例（8%）；肿瘤性 38 例（7%）；免疫/感染性 20 例（4%）；Phakomatoses 19 例（4%）；血管畸形 17 例（3%）；代谢性 3 例（<1%）；其他 90 例（17%）。874 例（46%）患者接受了 IV 钆剂。其中仅 48 例（5%）被回顾性认为需要使用 IV 钆剂：48 例中 15 例（31%）为免疫/感染性，33 例（69%）为肿瘤性。在 1010 例初始行非对比检查的患者中，有 15 例（1.5%）需要重复进行 IV 对比 MR 成像以进一步评估发现。
结论
在大多数情况下，急性儿科癫痫发作患者的影像学检查中，钆剂对比剂的附加益处有限。
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