Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Apr 28, 2023; 15(4): 127-135
Published online Apr 28, 2023. doi: 10.4329/wjr.v15.i4.127
Does sevoflurane sedation in pediatric patients lead to “pseudo” leptomeningeal enhancement in the brain on 3 Tesla magnetic resonance imaging?
Kiran Hilal, Kumail Khandwala, Saima Rashid, Faheemullah Khan, Shayan Sirat Maheen Anwar
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
Processing time: 65 Days and 18.5 Hours
ARTICLE HIGHLIGHTS
Research background

Prominent leptomeningeal contrast enhancement (LMCE) in the brain is seen in some pediatric patients during sedation for imaging. However, they are not acutely ill and do not exhibit meningeal signs. Our study determined whether inhaled sevoflurane anesthesia in pediatric patients led to pseudo LMCE (pLMCE) using 3 Tesla (3T) magnetic resonance imaging (MRI).

Research motivation

pLMCE on brain MRI in pediatric patients undergoing sedation with propofol has been studied. However, pLMCE due to sedation by sevoflurane (inhalation anesthetic) has not been studied so far. We therefore undertook this study in a small cohort of patients to establish our hypothesis.

Research objectives

The aim of this study was to highlight the significance of pLMCE in pediatric patients undergoing enhanced brain MRI under sedation to avoid misinterpretation in radiology reports.

Research methods

This was a retrospective cross-sectional study. Data analysis was performed by Statistical Package for Social Sciences version 20.0 software (IBM Corp.). Demographic data, such as age, were expressed as mean ± SD. The effect of age, weight and sex on LMCE was evaluated. The interobserver variability was calculated using Cohen’s kappa statistic. The LMCE grade was correlated with the duration of sedation and patient age and weight using the Spearman rho rank correlation. Correlation coefficients 0.1 < P < 0.3, 0.3 < P < 0.5 and > 0.5 were used as indications of weak, moderate and substantial associations, respectively. P < 0.05 was considered statistically significant.

Research results

There was substantial agreement between the two radiologists in detection of pLMCE on post-contrast T1 imaging (kappa = 0.61; P < 0.001). Our results show that this pattern may occur in younger and smaller pediatric patients due to their fragile and immature vasculature. Additionally, we found statistically significant inverse and moderate correlations between patient weight and age with pLMCE grade but no correlation between pLMCE and duration of sedation.

Research conclusions

Results of our study revealed that this pattern of pLMCE is relatively common on post-contrast spin echo T1-weighted sequences of younger pediatric patients sedated by sevoflurane, on 3T MRI and should not be misinterpreted for meningeal pathology.

Research perspectives

Future prospective studies with a larger cohort and controls are warranted to elucidate the exact relationship and evaluate any effect of magnetic strength and resolution on this finding.