Published online Apr 28, 2023. doi: 10.4329/wjr.v15.i4.127
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
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).
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.
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.
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.
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.
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.
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.