title: Should Intravenous Contrast be Administered in MRI Evaluation of Pediatric Outpatients with Chronic Headache?
abstract: BACKGROUND
  The practice of administering intravenous contrast to children varies by institution depending on their routine.
  
  
  OBJECTIVE
  To assess the necessity of routine contrast administration in brain magnetic resonance imaging (MRI) of pediatric outpatients referred for chronic headache workups.
  
  
  METHODS
  We conducted a retrospective review of consecutive pediatric brain MRI examinations performed during January and February 2014 in 30 pediatric outpatients referred for evaluation of chronic headache. Independent review was performed by two board-certified neuroradiologists. The raters reviewed each MRI first as a non-contrast examination (without seeing the post-contrast images) and then with post-contrast images.
  
  
  RESULTS
  No abnormalities were found in six patients. One patient had an indeterminate finding of a tubular cerebellar lesion requiring follow-up. In the remaining patients (n = 23), the findings were subclinical and included: mucosal thickening in the paranasal sinuses in 9 patients, cystic changes of the pineal gland in 8 (size 2-9 mm), small developmental venous anomalies in 6, non-specific FLAIR hyperintensities in 4, opacification of the mastoids in 2, and telangiectasia in 1 patient. The subclinical cases that were missed on pre-contrast images were: one small developmental venous anomaly, one telangiectasia and one small pineal cyst, none of which hold clinical significance. All kappa inter-rater and intra-rater agreement scores resulted in values above 0.75, excellent agreement according to Fleiss guidelines.
  
  
  CONCLUSIONS
  There seems to be little reason to medically justify large-scale use of routine IV contrast administration to evaluate a brain MRI of pediatric patients referred for chronic headache.
authors.forename: Sigal
authors.initials: S
authors.lastname: Tal
authors.forename: Michael
authors.initials: M
authors.lastname: Abrahamy
authors.forename: Paul
authors.initials: P
authors.lastname: Gottlieb
authors.forename: Hillel
authors.initials: H
authors.lastname: Maresky
authors.forename: Anna
authors.initials: A
authors.lastname: Ben Ely
mesh_terms: D000293:Adolescent; D002648:Child; D003287:Contrast Media / Q000008:administration & dosage*; D005260:Female; D020773:Headache Disorders / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D010045:Outpatients; D012189:Retrospective Studies
chemical_list: D003287:Contrast Media