Use of fast-sequence spine MRI in pediatric patients

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  • 1 Department of Neurological Surgery and
  • 2 Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri; and
  • 3 Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, Maryland
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OBJECTIVE

The 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.

METHODS

After 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.

RESULTS

A 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.

CONCLUSIONS

The 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.

ABBREVIATIONS fsMRI = fast-sequence MRI; HASTE = half-Fourier acquisition single-shot turbo spin echo; IPAT = integrated parallel imaging technique; SPACE = sampling perfection with application-optimized contrasts using different flip-angle evolutions.

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Contributor Notes

Correspondence Jennifer M. Strahle: Washington University in St. Louis, MO. strahlej@wustl.edu.

INCLUDE WHEN CITING Published online September 18, 2020; DOI: 10.3171/2020.5.PEDS20137.

Disclosures Dr. Limbrick received support of a non–study-related clinical or research effort that he oversaw from Medtronic, Inc., and Microbot Medical, Inc. Dr. McKinstry received travel and meal expenses from Siemens Healthineers.

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