Results of a North American survey of rapid-sequence MRI utilization to evaluate cerebral ventricles in children

Clinical article

Eric M. Thompson M.D., Lissa C. Baird M.D. and Nathan R. Selden M.D., Ph.D.
View More View Less
  • Department of Neurological Surgery, Oregon Health & Science University, Portland, Oregon
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object

Growing concern about potential adverse effects of ionizing radiation exposure during imaging studies is particularly relevant to the pediatric population. To decrease radiation exposure, many institutions use rapid-sequence (or quick-brain) MRI to evaluate cerebral ventricle size. There are obstacles, however, to widespread implementation of this imaging modality. The purpose of this study was to define and quantify these obstacles to positively affect institutional and governmental policy.

Methods

A 9-question survey was emailed to pediatric neurosurgeons who were either members or candidate members of the American Society of Pediatric Neurosurgeons at every one of 101 institutions in the US and Canada having such a neurosurgeon on staff. Responses were compiled and descriptive statistics were performed.

Results

Fifty-six institutions completed the survey. Forty-four (79%) of the 56 institutions currently have a rapid-sequence MRI protocol to evaluate ventricle size, while 36 (64%) use it routinely. Of the 44 institutions with a rapid-sequence MRI protocol, 29 (66%) have had a rapid-sequence MRI protocol for less than 5 years while 39 (89%) have had a rapid-sequence MRI protocol for no more than 10 years. Thirty-six (88%) of 41 rapid-sequence MRI users responding to this question obtain a T2-weighted rapid-sequence MRI while 13 (32%) obtain a T1-weighted rapid-sequence MRI. Twenty-eight (64%) of 44 institutions never use sedation while an additional 12 (27%) rarely use sedation to obtain a rapid-sequence MRI (less than 5% of studies). Of the institutions with an established rapid-sequence MRI protocol, obstacles to routine use include lack of emergency access to MRI facilities in 18 (41%), lack of staffing of MRI facilities in 12 (27%), and the inability to reimburse a rapid-sequence MRI protocol in 6 (14%). In the 12 institutions without rapid-sequence MRI, obstacles to implementation include lack of emergency access to MRI facilities in 8 (67%), lack of staffing of MRI facilities in 7 (58%), the inability to reimburse in 3 (25%), and lack of administrative support in 3 (25%). To evaluate pediatric head trauma, 53 (96%) of 55 institutions responding to this question use noncontrast CT, no institution uses rapid-sequence MRI, and only 2 (4%) use standard MRI.

Conclusions

Many North American institutions have a rapid-sequence MRI protocol to evaluate ventricle size, with most developing this technique within the past 5 years. Most institutions never use sedation, and most obtain T2-weighted sequences. The greatest obstacles to the routine use of rapid-sequence MRI in institutions with and in those without a rapid-sequence MRI protocol are the lack of emergency access and staffing of the MRI facility during nights and weekends.

Abbreviation used in this paper:TBI = traumatic brain injury.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address correspondence to: Nathan R. Selden, M.D., Ph.D., Neurological Surgery, Oregon Health & Science University, Mail code CH8N, 3303 S.W. Bond Ave., Portland, OR 97239. email: seldenn@ohsu.edu.

Please include this information when citing this paper: published online April 11, 2014; DOI: 10.3171/2014.2.PEDS13567.

  • 1

    Ashley WW Jr, , McKinstry RC, , Leonard JR, , Smyth MD, , Lee BC, & Park TS: Use of rapid-sequence magnetic resonance imaging for evaluation of hydrocephalus in children. J Neurosurg 103:2 Suppl 124130, 2005

    • Search Google Scholar
    • Export Citation
  • 2

    Ba-Ssalamaha A, , Schick S, , Heimberger K, , Linnau KF, , Schibany N, & Prokesch R, : Ultrafast magnetic resonance imaging of the brain. Magn Reson Imaging 18:237243, 2000

    • Search Google Scholar
    • Export Citation
  • 3

    Berrington de González A, , Mahesh M, , Kim KP, , Bhargavan M, , Lewis R, & Mettler F, : Projected cancer risks from computed tomographic scans performed in the United States in 2007. Arch Intern Med 169:20712077, 2009

    • Search Google Scholar
    • Export Citation
  • 4

    Brenner DJ, & Hall EJ: Computed tomography—an increasing source of radiation exposure. N Engl J Med 357:22772284, 2007

  • 5

    Drake JM, , Kestle JR, , Milner R, , Cinalli G, , Boop F, & Piatt J Jr, : Randomized trial of cerebrospinal fluid shunt valve design in pediatric hydrocephalus. Neurosurgery 43:294305, 1998

    • Search Google Scholar
    • Export Citation
  • 6

    Farrell BT, , Pollock J, , Riccelli L, , Anderson J, , Bardo D, & Guillaume D: Preliminary experience with quick-spine magnetic resonance imaging for evaluation of cervical spine trauma in children. J Neurosurg 119:A547, 2013. (Abstract)

    • Search Google Scholar
    • Export Citation
  • 7

    Gaskill SJ, & Marlin AE: Radiation exposure in the myelomeningocele population. Pediatr Neurosurg 28:6366, 1998

  • 8

    Iskandar BJ, , Sansone JM, , Medow J, & Rowley HA: The use of quick-brain magnetic resonance imaging in the evaluation of shunt-treated hydrocephalus. J Neurosurg 101:2 Suppl 147151, 2004

    • Search Google Scholar
    • Export Citation
  • 9

    Koral K, , Blackburn T, , Bailey AA, , Koral KM, & Anderson J: Strengthening the argument for rapid brain MR imaging: estimation of reduction in lifetime attributable risk of developing fatal cancer in children with shunted hydrocephalus by instituting a rapid brain MR imaging protocol in lieu of head CT. AJNR Am J Neuroradiol 33:18511854, 2012

    • Search Google Scholar
    • Export Citation
  • 10

    Miller JH, , Walkiewicz T, , Towbin RB, & Curran JG: Improved delineation of ventricular shunt catheters using fast steady-state gradient recalled-echo sequences in a rapid brain MR imaging protocol in nonsedated pediatric patients. AJNR Am J Neuroradiol 31:430435, 2010

    • Search Google Scholar
    • Export Citation
  • 11

    Missios S, , Quebada PB, , Forero JA, , Durham SR, , Pekala JS, & Eskey CJ, : Quick-brain magnetic resonance imaging for nonhydrocephalus indications. Clinical article. J Neurosurg Pediatr 2:438444, 2008

    • Search Google Scholar
    • Export Citation
  • 12

    O'Neill BR, , Pruthi S, , Bains H, , Robison R, , Weir K, & Ojemann J, : Rapid sequence magnetic resonance imaging in the assessment of children with hydrocephalus. World Neurosurg 80:e307e312, 2013

    • Search Google Scholar
    • Export Citation
  • 13

    Pindrik J, , Huisman TA, , Mahesh M, , Tekes A, & Ahn ES: Analysis of limited-sequence head computed tomography for children with shunted hydrocephalus: potential to reduce diagnostic radiation exposure. Laboratory investigation. J Neurosurg Pediatr 12:491500, 2013

    • Search Google Scholar
    • Export Citation
  • 14

    United States Nuclear Regulatory Commission: Subpart C–occupational dose limits. 10 C.F.R. § 20.1201. (http://www.nrc.gov/reading-rm/doc-collections/cfr/part020/part020-1201.html) [Accessed March 2, 2014]

  • 15

    United States Nuclear Regulatory Commission: Subpart D–radiation dose limits for individual members of the public. 10 C.F.R. § 20.1301. (http://www.nrc.gov/reading-rm/doccollections/cfr/part020/part020-1301.html) [Accessed March 2, 2014]

  • 16

    Wait SD, , Lingo R, , Boop FA, & Einhaus SL: Eight-second MRI scan for evaluation of shunted hydrocephalus. Childs Nerv Syst 28:12371241, 2012

    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 115 115 14
Full Text Views 331 129 0
PDF Downloads 206 35 0
EPUB Downloads 0 0 0