E1717. Non-Sedated Pediatric Fast Spine MR Imaging
  1. Claire Stephanie Adcock; Medical University of South Carolina
  2. Madison Kocher; Medical University of South Carolina
  3. Abigail Truitt; Medical University of South Carolina
  4. Georgia Lydon; Medical University of South Carolina
  5. Justin Chetta; Medical University of South Carolina
  6. Milad Yazdani; Medical University of South Carolina
  7. Maria Spampinato; Medical University of South Carolina
Studies have shown the potential negative long-term effects of general anesthesia on pediatric neurodevelopment. As a result, there is an increased interest in pediatric magnetic-resonance imaging (MRI) protocols not requiring sedation. While fast brain MRI studies are widely used in clinical practice, the potential role for fast non-sedated spine MRI in pediatric patients requires further determination. The purpose of this study was to evaluate the image quality and efficacy of a pediatric non-sedated fast spine MRI protocol.

Materials and Methods:
We performed a retrospective review of 69 nonsedated fast spine MRI examinations (31 cervical, 13 thoracic, and 25 lumbar spine) performed at our institution over the course of seven months. The protocol included sagittal and axial T2 HASTE, sagittal and axial turbo spin-echo T1, and sagittal STIR (duration less than 7 minutes). Two board-certified neuroradiologists performed independent assessments of the image quality of each study, including assessment of bones, cerebrospinal fluid (CSF) spaces, spinal cord, soft tissues, ligaments, and overall interpretability using a 5-point scoring system (ranging from 1 = nondiagnostic study, to 5 = excellent image quality). We also reviewed any standard spine MRI obtained within 3 months after the fast MRI. Inter-rater reliability was assessed with the intraclass correlation coefficient (ICC).

Mean patient age was 7.3 years (SD = 5.4, range = <1 - 17). Most common indications included Chiari malformation, numbness/paresthesia, and syrinx. The interobserver agreement between the two readers ranged between good and excellent for each evaluated variable (ICC range = 0.620 - 0.815). Then, we averaged the ratings of the two readers. Overall mean interpretability rating was 3.7/5 (SD = 0.8). The highest ratings were given to the evaluation of the CSF spaces and cranio-cervical junction, with average ratings of 3.5/5 for both variables. Ratings stratified by age were worst in the <1 - 4 years group. Ratings did not differ among spine regions (cervical, thoracic, and lumbar). In two of the 69 patients (2.9%) a standard spine MRI was performed to better characterize findings seen on the fast spine MRI. The two follow-up standard MR exams were performed to better evaluate an enlargement of the dorsal thoracic CSF spaces in a 16-year-old patient with ADHD and radiculopathy, and thoracic spinal cord atrophy in a 13-year-old patient with history of treated spinal AVM.

Nonsedated pediatric fast spine MRI protocol could be a suitable screening tool for the evaluation of spine pathology.