E1372. Rapid MRI for Emergent Shunt Evaluation in Children: A Missed Opportunity
  1. Timothy Hagan; University of Texas Southwestern
  2. Nishika Karbhari; Dartmouth-Hitchcock
  3. Donald Chan; Riverside Community Hospital
  4. Patrick Arraj; University of Texas Southwestern
  5. Nisha Reddy; University of Texas Southwestern
  6. Cory Pfeifer; University of Texas Southwestern
Children with chronic indwelling ventriculoperitoneal shunt catheters are at risk for infection, shunt malfunction, and hardware compromise. As such, these children are often subject to emergency head imaging. Computed tomography (CT) is regularly favored given ease of access and speed. Rapid magnetic resonance imaging (MRI) has been used to evaluate ventricular size for many years and avoids the need for ionizing radiation. Multiple studies have validated the efficacy of the rapid MRI for shunt evaluation, yet many providers prefer CT nonetheless. This study evaluates this practice pattern as a means to promote better imaging practices for this population.

Materials and Methods:
All CT and rapid MRI studies ordered for shunt evaluation in a large pediatric tertiary care health system in a calendar year were reviewed. Each cohort was stratified by ordering location, time ordered, and status as a follow-up study within the year.

A total of 679 rapid MRI and 502 CT studies were ordered for shunt evaluation. Rapid MRI for shunt evaluation was largely an outpatient study, as outpatient exams represented 86.1% of the rapid MRI requests. Only 2.7% of the rapid MRI studies were ordered from the emergency department. Only 9.6% of CT studies were performed during the hours when MRI technologists were not routinely available in the department. 18.7% of patients undergoing rapid MRI for shunt evaluation also received a CT for the same indication within the year studied.

CT remains the modality preferred by pediatric emergency medicine providers to evaluate shunt function despite availability of rapid MRI. Pediatric emergency providers may be unaware that hospitals serving children have markedly enhanced rapid MRI imaging practices in recent years as part of initiatives to decrease general anesthesia and radiation. Radiologists that offer imaging for this indication in children should educate ordering providers to promote appropriate imaging practices.