Test characteristics of quick brain MRI for shunt evaluation in children: an alternative modality to avoid radiation
Test characteristics of quick brain MRI for shunt evaluation in children: an alternative modality to avoid radiation
复制标题
DOI：
10.3171/2014.9.peds14207
复制
发表时间：
2015-04-01
影响因子：
1.9
通讯作者：
Spiro, David M.
中科院分区：
文献类型：
--
作者：
Yue, Esther L.;Meckler, Garth D.;Spiro, David M.
目的：快速脑磁共振成像（QB-MRI）是一种快速、无辐射的技术，可检测危及生命的脑脊液分流功能障碍。QB-MRI尚未被广泛研究或采用。本研究的主要目的是评估QB-MRI检测分流管故障的测试特性。然后比较脑CT和QB-MRI的测试特征。次要目标包括比较两种模式下完成研究的时间和镇静剂的使用，以及在实施儿科急诊科（PED）分流临床路径之前和之后QB-MRI完成研究的时间的比较。方法对2所三级医院儿科进行回顾性分析。作者回顾了2008年7月至2012年6月期间因疑似分流管故障而接受QB-MRI或CT检查的儿童的图表。他们还回顾了患者的神经放射学报告，并将心室大小分为阳性（增大）或阴性（正常、较小或不变）。分流管功能障碍在30天内进行手术翻修。结果共纳入997例PED就诊（包括724例qb - mri和273例ct）。手术翻修235例（23.6%）。QB-MRI的敏感性为58.5% (95% CI为51.1% ~ 65.6%)，特异性为93.3%（90.8% ~ 95.3%）。CT的敏感性为53.2% (95% CI 38.1% ~ 67.9%)，特异性为95.6%（92% ~ 97.9%）。完成QB-MRI的平均时间为115分钟，而CT为83分钟（差异32分钟，95% Cl， 22-42分钟，p < 0.001）。应用脑脊液分流途径前从表现到完成QB-MRI检查的平均时间为132分钟，而应用脑脊液分流途径后为112分钟（差异20分钟，95% CI 5-35分钟，p = 0.01）。3.7%的CT研究和4.4%的QB-MRI研究使用了抗焦虑药物（p = 0.74）。结论QB-MRI与CT在检测儿童脑脊液分流管功能障碍方面具有相似的检测特点，对镇静的要求也相似。QB-MRI从顺序放置到成像完成的时间间隔较长，这是有争议的，因为在频繁脑成像的人群中，辐射暴露减少了。
OBJECT Quick brain magnetic resonance imaging (QB-MRI) is a rapid, radiation-free technique to detect life-threatening CSF shunt malfunction. QB-MRI has not been widely studied or adopted. The primary objective of this study was to evaluate the test characteristics of QB-MRI for detecting shunt malfunction. Test characteristics of brain computed tomography (CT) and QB-MRI were then compared. Secondary objectives included comparison of time to study completion,and use of sedatives for both modalities, as well as comparison of time to study completion for QB-MRI before and after implementation of a Pediatric Emergency Department (PED) shunt clinical pathway.METHODS A retrospective chart review was performed at 2 tertiary care hospital PEDs. The authors reviewed the charts of children who underwent QB-MRI or CT for suspected shunt malfunction between July 2008 and June 2012. They also reviewed the patients' neuroradiology reports and classified ventricular size as positive (enlarged) or negative (normal, smaller, or unchanged). Shunt malfunction was defined by surgical revision within 30 days.RESULTS Nine hundred ninety-seven PED visits (involving 724 QB-MRIs and 273 CTs) were included. Surgical revision was performed in 235 cases (23.6%). For QB-MRI, sensitivity was 58.5% (95% CI 51.1%-65.6%) and specificity was 93.3% (90.8%-95.3%). For CT, sensitivity was 53.2% (95% CI 38.1%-67.9%) and specificity was 95.6% (92%-97.9%). The mean time to completion of QB-MRI was 115 minutes versus 83 minutes for CT (difference 32 minutes, 95% Cl, 22-42 minutes, p < 0.001). The mean time from presentation to completion of QB-MRI prior to application of the CSF shunt pathway was 132 minutes versus 112 minutes after application of the CSF shunt pathway (difference 20 minutes, 95% CI 5-35 minutes, p = 0.01). Anxiolytic medications were used in 3.7% of CT studies and 4.4% of QB-MRI studies (p = 0.74).CONCLUSIONS QB-MRI and CT have similar test characteristics for detecting CSF shunt malfunction in children and similar requirements for sedation. The longer interval from order placement to imaging completion for QB-MRI is arguably justified by reduction of radiation exposure in this population subject to frequent brain imaging.