Use of rapid-sequence magnetic resonance imaging for evaluation of hydrocephalus in children.
OBJECTIVE
The authors examine the use of rapid-sequence magnetic resonance (rsMR) imaging to make the diagnosis of malfunctioning and/or infected shunts in patients with hydrocephalus. Computerized tomography (CT) scanning is usually used in this context because it rapidly acquires high-quality images, yet it exposes pediatric patients to particularly high levels of radiation. Standard MR imaging requires longer image acquisition time, is associated with movement artifact, and, in children, usually requires sedation. Standard MR imaging provides greater structural resolution, yet visualization of ventricular catheters is relatively poor.


METHODS
The authors analyzed a series of 67 rsMR imaging examinations performed without sedation in pediatric patients with hydrocephalus whose mean age was 4 years at the time of the examination. The mean study duration was 22 minutes. Catheter visualization was good or excellent in more than 75% of studies reviewed, and image quality was good or excellent in more than 60% of studies reviewed. The authors analyzed cancer risk with a model used for atomic bomb survivors. Fifty percent of their patients with hydrocephalus had undergone more than four brain imaging studies (CT or MR imaging) in their lifetimes. For the many patients who had undergone more than 15 studies, the total estimated lifetime attributable cancer mortality risk was calculated to be at least 0.35%.


CONCLUSIONS
Rapid-sequence MR imaging yields reliable visualization of the ventricular catheter and offers superior anatomical detail while limiting radiation exposure. The authors' protocol is rapid and each image is acquired separately; therefore, motion artifact is reduced and the need for sedation is eliminated. They recommend the use of rsMR imaging for nonemergent evaluation of pediatric hydrocephalus.
Ashley
William W
WW
Department of Neurosurgery, St Louis Children's Hospital, Missouri 63110-1077, USA.
McKinstry
Robert C
RC
Leonard
Jeffrey R
JR
Smyth
Matthew D
MD
Lee
Benjamin C
BC
Park
Tae Sung
TS
D000293:Adolescent; D000328:Adult; D001424:Bacterial Infections / Q000175:diagnosis*; D002408:Catheters, Indwelling / Q000382:microbiology*; D002557:Cerebrospinal Fluid Shunts / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004868:Equipment Failure; D005260:Female; D017048:Health Care Costs; D006801:Humans; D006849:Hydrocephalus / Q000175:diagnosis* / Q000601:surgery*; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D008297:Male; D009381:Neoplasms, Radiation-Induced / Q000209:etiology; D018570:Risk Assessment; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000009:adverse effects / Q000191:economics