title: Assessment of sedated pediatric brain with 3D-FLAIR sequence at 3T MRI.
abstract: OBJECTIVE
  In sedated pediatric brains, 2D-FLAIR causes increased signal intensity of the cerebrospinal fluid (CSF) leading to false-positive diagnoses. Our aim is to determine whether increased CSF signal intensity is observed on 3D-FLAIR images.
  
  
  METHODS
  In this institutional review board-approved study, a 2-year retrospective analysis of our MRI database was conducted which revealed 48 sedated pediatric patients with normal cranial MRI findings and 3D-FLAIR sequence. One adult volunteer was imaged before and after O2 inhalation with 2D and 3D-FLAIR sequences. The hyperintensity in the subarachnoid spaces and basal cisterns were quantified as follows: 0: artifact free; 1: homogeneous minimal CSF signal; 2: abnormal CSF signal. Inter-observer agreement was assessed with kappa agreement analysis.
  
  
  RESULTS
  Grade 0 and grade 1 signals were observed at inferior to Liliequist membrane (LLQ) in 48/48 and 0/48 cases; prepontine cistern 47/48 and 1/48; superior to LLQ 26/48 and 22/48; 4th ventricle 16/48 and 32/48; 3rd ventricle 34/48 and 14/48; lateral ventricle 3/48 and 45/48; subarachnoid space 36/48 and 12/48, respectively. No patients showed grade 2 signal. Inter-observer agreement was 0.81-1. In the volunteer, after O2 inhalation, grade 2 signal intensity was evident on 2D-FLAIR however; 3D-FLAIR did not show any signal increase.
  
  
  CONCLUSIONS
  In sedated pediatric brains, 3D-FLAIR suppresses CSF signal, and enables reliable assessment free from CSF artifacts.
authors.affiliation: Department of Radiology, Acibadem University School of Medicine, Istanbul, Turkey. Electronic address: umit.ozcan@acibadem.edu.tr.
authors.forename: Umit Aksoy
authors.initials: UA
authors.lastname: Ozcan
authors.affiliation: Department of Pediatrics, Division of Pediatric Neurology, Acibadem University School of Medicine, Istanbul, Turkey.
authors.forename: Ugur
authors.initials: U
authors.lastname: Isik
authors.affiliation: Oregon Health and Science University School of Medicine, Portland, OR, USA.
authors.forename: Alp
authors.initials: A
authors.lastname: Ozpinar
authors.affiliation: Department of Anesthesiology, Acibadem University School of Medicine, Istanbul, Turkey.
authors.forename: Nigar
authors.initials: N
authors.lastname: Baykan
authors.affiliation: Department of Radiology, Acibadem University School of Medicine, Istanbul, Turkey.
authors.forename: Alp
authors.initials: A
authors.lastname: Dincer
mesh_terms: D000768:Anesthesia, General / Q000379:methods; D001921:Brain / Q000473:pathology / Q000502:physiology*; D002555:Cerebrospinal Fluid / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D021621:Imaging, Three-Dimensional / Q000379:methods; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D015588:Observer Variation; D012189:Retrospective Studies
chemical_list: D006993:Hypnotics and Sedatives
keywords: Brain; Cerebrospinal fluid; FLAIR; Magnetic resonance imaging