Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Apr 28;15(4):127-135.
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  1 , Kumail Khandwala  1 , Saima Rashid  2 , Faheemullah Khan  1 , Shayan Sirat Maheen Anwar  3
Affiliations

Does sevoflurane sedation in pediatric patients lead to "pseudo" leptomeningeal enhancement in the brain on 3 Tesla magnetic resonance imaging?

Kiran Hilal et al. World J Radiol. .

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.

Keywords: 3 Tesla magnetic resonance imaging; Brain; Gadolinium contrast; Pediatrics; Pseudo leptomeningeal enhancement; Sevoflurane.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest statement: All authors declare having no conflicts of interest with any related company, institution or individual.

Figures

Figure 1
Figure 1
Mild pseudo leptomeningeal contrast enhancement in a 7-mo-old male with infantile spasms (Grade 1). A: Axial spin echo T1-weighted images; B: Axial post-contrast spin echo T1-weighted images showed pseudo leptomeningeal contrast enhancement as small vascular structures (arrows) within the depths of the sulci.
Figure 2
Figure 2
Moderate pseudo leptomeningeal contrast enhancement a 7-yr-old female with developmental delays (Grade 2). A: Axial spin echo T1-weighted imaging; B: Axial post-contrast T1-weighted imaging showed pseudo leptomeningeal contrast enhancement as smooth and slightly thickened enhancements (arrows) throughout the depths of the sulci.
Figure 3
Figure 3
Severe pseudo leptomeningeal contrast enhancement in a 4-mo-old female with metabolic disorder (Grade 3). A: Axial spin echo T1-weighted imaging; B: Axial post-contrast spin echo T1-weighted imaging demonstrated thicker pseudo leptomeningeal contrast enhancement (arrows), appearing nearly nodular or parenchymal in some locations.
See this image and copyright information in PMC

References

    1. Smirniotopoulos JG, Murphy FM, Rushing EJ, Rees JH, Schroeder JW. Patterns of contrast enhancement in the brain and meninges. Radiographics. 2007;27:525–551. - PubMed
    1. Bhargava R, Hahn G, Hirsch W, Kim MJ, Mentzel HJ, Olsen OE, Stokland E, Triulzi F, Vazquez E. Contrast-enhanced magnetic resonance imaging in pediatric patients: review and recommendations for current practice. Magn Reson Insights. 2013;6:95–111. - PMC - PubMed
    1. Mongodi S, Ottonello G, Viggiano R, Borrelli P, Orcesi S, Pichiecchio A, Balottin U, Mojoli F, Iotti GA. Ten-year experience with standardized non-operating room anesthesia with Sevoflurane for MRI in children affected by neuropsychiatric disorders. BMC Anesthesiol. 2019;19:235. - PMC - PubMed
    1. Malviya S, Voepel-Lewis T, Eldevik OP, Rockwell DT, Wong JH, Tait AR. Sedation and general anaesthesia in children undergoing MRI and CT: adverse events and outcomes. Br J Anaesth. 2000;84:743–748. - PubMed
    1. Malviya S, Voepel-Lewis T, Tait AR. Adverse events and risk factors associated with the sedation of children by nonanesthesiologists. Anesth Analg. 1997;85:1207–1213. - PubMed