Non-sedated fast spine magnetic resonance imaging in pediatric patients

Background Traditional spine magnetic resonance imaging (MRI) protocols require sedation in young children and uncooperative patients. There is an increased interest in non-sedated pediatric MRI protocols to reduce risks associated with anesthetic agents and improve MRI access. Objective To evaluate the image quality of pediatric non-sedated fast spine MRI. Materials and methods We retrospectively reviewed 69 pediatric non-sedated fast spine MRI exams performed in 57 patients. Two blinded readers provided image quality ratings for the evaluation of bones, cranio-cervical junction, cerebrospinal fluid (CSF) spaces, spinal cord, soft tissues, ligaments, and overall diagnostic quality on a 1-5 scale, and determined whether there was evidence of syringomyelia, abnormal conus medullaris position, or filum terminale abnormality. Results Mean patient age was 7.2 years (age range <= 1- 17). Indications included syringomyelia (n=25), spinal dysraphism (n=4), combination of both syringomyelia and spinal dysraphism ( n=8), and other miscellaneous indications (n=32). The inter- observer agreement ranged between moderate and very good for each variable (Cohen's weighted kappa] range=0.450.69). The highest image quality ratings were given to CSF spaces (mean image quality=3.5/5 +/- 0.8) and cranio-cervical junction evaluations (3.5/5 +/- 0.9). Overall diagnostic quality was worst in the <5 years group (P=0.006). Readers independently identified a cervical spinal cord syrinx in 6 cases, and 1 mm spinal cord central canal dilation in one case. Readers agreed on the position of the conus medullaris in 92% of cases (23/25 cases). Conclusion Non-sedated pediatric spine MRI can be an effective diagnostic test to evaluate for spine pathology, especially syringomyelia, Chiari malformation, and conus medullaris anatomy.