Hilal K, Khandwala K, Rashid S, Khan F, Anwar SSM. Does sevoflurane sedation in pediatric patients lead to “pseudo” leptomeningeal enhancement in the brain on 3 Tesla magnetic resonance imaging? World J Radiol 2023; 15(4): 127-135 [PMID: 37181823 DOI: 10.4329/wjr.v15.i4.127]
Corresponding Author of This Article
Shayan Sirat Maheen Anwar, FCPS, MBBS, Assistant Professor, Department of Radiology, Aga Khan University Hospital, National Stadium Rd, Karachi 74800, Pakistan. shayan.anwar@aku.edu
Research Domain of This Article
Radiology, Nuclear Medicine & Medical Imaging
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Kiran Hilal, Kumail Khandwala, Faheemullah Khan, Shayan Sirat Maheen Anwar, Department of Radiology, Aga Khan University Hospital, Karachi 74800, Pakistan
Saima Rashid, Department of Anesthesiology, Aga Khan University Hospital, Karachi 74800, Pakistan
Author contributions: Hilal K contributed to conceptualization, methodology, supervision, reviewing and editing; Khandwala K contributed to formal analysis and original draft preparation; Rashid S contributed to data curation, visualization and investigation; Khan F contributed to data curation and software; Anwar SSM contributed to reviewing and editing; all authors have participated in final editing of the drafts and have reviewed the final version of the paper.
Institutional review board statement: This study was approved by the Ethics Committee of Aga Khan University Hospital on April 22, 2020 (2020-3611-9104).
Informed consent statement: There was no direct patient contact and no intervention. It was just a retrospective review of files and images that is why the patient consent was waived by the ethical review committee.
Conflict-of-interest statement: All authors declare having no conflicts of interest with any related company, institution or individual.
Data sharing statement: The dataset may be provided by the corresponding author upon reasonable request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Noncommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shayan Sirat Maheen Anwar, FCPS, MBBS, Assistant Professor, Department of Radiology, Aga Khan University Hospital, National Stadium Rd, Karachi 74800, Pakistan. shayan.anwar@aku.edu
Received: February 19, 2023 Peer-review started: February 19, 2023 First decision: March 15, 2023 Revised: March 28, 2023 Accepted: April 18, 2023 Article in press: April 18, 2023 Published online: April 28, 2023
Abstract
BACKGROUND
Prominent leptomeningeal contrast enhancement (LMCE) in the brain is observed in some pediatric patients during sedation for imaging. However, based on clinical history and cerebrospinal fluid analysis, the patients are not acutely ill and do not exhibit meningeal signs. Our study determined whether sevoflurane inhalation in pediatric patients led to this pattern of ‘pseudo’ LMCE (pLMCE) on 3 Tesla magnetic resonance imaging (MRI).
AIM
To highlight the significance of pLMCE in pediatric patients undergoing enhanced brain MRI under sedation to avoid misinterpretation in reports.
METHODS
A retrospective cross-sectional evaluation of pediatric patients between 0-8 years of age was conducted. The patients underwent enhanced brain MRI under inhaled sevoflurane. The LMCE grade was determined by two radiologists, and interobserver variability of the grade was calculated using Cohen’s kappa. The LMCE grade was correlated with duration of sedation, age and weight using the Spearman rho rank correlation.
RESULTS
A total of 63 patients were included. Fourteen (22.2%) cases showed mild LMCE, 48 (76.1%) cases showed moderate LMCE, and 1 case (1.6%) showed severe LMCE. We found substantial agreement between the two radiologists in detection of pLMCE on post-contrast T1 imaging (kappa value = 0.61; P < 0.001). Additionally, we found statistically significant inverse and moderate correlations between patient weight and age. There was no correlation between duration of sedation and pLMCE.
CONCLUSION
pLMCE is relatively common on post-contrast spin echo T1-weighted MRI of pediatric patients sedated by sevoflurane due to their fragile and immature vasculature. It should not be misinterpreted for meningeal pathology. Knowing pertinent clinical history of the child is an essential prerequisite to avoid radiological overcalling and the subsequent burden of additional investigations.
Core Tip: Prominent leptomeningeal contrast enhancement (LMCE) in the brain is seen in some pediatric patients during sedation for imaging, but they do not exhibit meningeal disease. This pattern of pseudo LMCE is relatively common on post-contrast spin echo-T1-weighted magnetic resonance imaging of pediatric patients sedated by sevoflurane due to their fragile and immature vasculature. Knowing pertinent clinical history is an essential prerequisite to avoid radiological overcalling and additional investigations. Our study determined whether sevoflurane inhalation in pediatric patients led to pseudo LMCE on 3 Tesla magnetic resonance imaging.
