Verzicht auf Sedierungen bei pädiatrischen MRT-Untersuchungen des Kopfes: Was ist machbar?

Zusammenfassung

Ziel: Machbarkeitsstudie zur Frage, inwieweit die Akquisition einer diagnostischen Schädel-MRT beim Kind mit rotierend den k-Raum auslesenden BLADE-Sequenzen nach altersgerechter Patientenvorbereitung möglich ist.

Material und Methoden: Im Zeitraum 01/09 – 12/10 wurden alle zur Schädel-MRT vorgestellten Kinder eingeschlossen. Nach altersgerechter Vorbereitung wurde die MRT mit BLADE-Sequenzen in Beisein eines Elternteils ohne Sedierung akquiriert; nur bei starken Bewegungsartefakten wurden Sedierungen durchgeführt. Alle Bilder wurden durch 2 Radiologen hinsichtlich Bildqualität und Artefakten bewertet (III = sehr gut, II = diagnostisch ausreichend, I = nicht diagnostisch).

Ergebnisse: 326 Kinder (53 % männlich, DA 7,2 ± 4,3 Jahre) wurden untersucht, davon 247 (76 %) ohne Sedierung. Alle Säuglinge sowie 84 % der Einjährigen, 90 % der 2-Jährigen, 59 % der 3-Jährigen, 9 % der 4-Jährigen und 2 % der Kinder jenseits des 5. Lebensjahres mussten medikamentös sediert werden. Insgesamt wurden 2461 Sequenzen (7,6 ± 1,2 pro Studie) mit 622 BLADE-Sequenzen (25 %) akquiriert. Untersucher A bewertete 2077 Sequenzen (84 %) mit III, 318 (13 %) mit II und 66 (3 %) mit I, während Untersucher B 2119 Sequenzen (86 %) mit III, 308 (13 %) mit II und 34 (1 %) mit I bewertete. Zwischen den Untersuchern fanden sich gute bis ausgezeichnete Übereinstimmungen (einfacher/gewichteter Kappa-Wert für BLADE-Sequenzen: 0,88/0,56, für alle Sequenzen: 0,92/0,71).

Schlussfolgerung: Altersgerechte Vorbereitungen und Durchführungen von Schädel-MRT-Untersuchungen bei Kindern können die Notwendigkeit von Sedierungen reduzieren. BLADE-Sequenzen verringern Bewegungsartefakte und ermöglichen damit auch bei kleinen Kindern die Akquisition diagnostisch aussagekräftiger Bilder. Für Patienten ab dem 4. Lebensjahr sollte ein Verzicht auf Sedierungen versucht werden.

Abstract

Purpose: Feasibility study to evaluate whether a diagnostic pediatric MRI scan of the brain can be performed without sedation by using BLADE sequences with rotating blade-like k-space covering.

Materials and Methods: Between 01/09 and 12/10 all children with a planned MRI of the brain were included. After age-dependent preparation of the child the MRI was acquired with a parent closely attending. Pharmacological sedation was only applied when strong motion artifacts occurred. All MRI sequences were independently reviewed by 2 radiologists who ranked image quality on a scale of III (excellent image quality, no motion artefacts), II (motion artefacts but still diagnostic quality), and I (non-diagnostic image quality).

Results: 326 children (53 % male, mean age 7.2 ± 4.3 years) were evaluated of whom 247 (76 %) had to be sedated. All infants < 1 year and 84 % of 1-year-old patients, 90 % of 2-year-old, 59 % of 3-year-old, 9 % of 4-year-old children, and 2 % of patients older than 4 years had to be sedated. In total, 2461 MRI sequences (7.6 ± 1.2 per study) including 622 BLADE sequences (25 %) were acquired. Reviewer A rated 2077 sequences (84 %) as III, 318 (13 %) as II, and 66 (3 %) as I, whereas reviewer B rated 2119 sequences (86 %) as III, 308 (13 %) as II, and 34 (1 %) as I. Inter-observer agreement was good to excellent (normal/weighted kappa value for BLADE sequences: 0.88/0.56, for all sequences: 0.92/0.71).

Conclusion: Age-adjusted preparation and implementation of a pediatric cranial MRI may reduce the need for sedation. BLADE sequences abate motion artefacts thus enabling acquisition of diagnostic images even in young children. In patients older than 3 years, performance of MRI scans without sedation should be considered.

Key words

CNS - brain - MR-imaging

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