Does oxygen use during general anesthesia cause an artifact in magnetic resonance images?

Yıl 2012, Cilt: 3 Sayı: 4, 477 - 482, 01.12.2012

H. Volkan Acar Hasan Yiğit Fatoş Korkulu Ayşegül Ceyhan Pınar Nercis Koşar Bayazit Dikmen

https://doi.org/10.5799/ahinjs.01.2012.04.0206

Öz

Objectives: In this study our aim was to compare possible effects of two different oxygen concentrations (100% vs. 50%) on hyperintense signal abnormality (HSA) in pediatric patients undergoing cranial magnetic resonance imaging (MRI) under sevoflurane anesthesia. Materials and methods: Thirty pediatric patients undergoing cranial MRI were studied. Sevoflurane was used for induction and maintenance of anesthesia with an MR-compatible anesthesia machine. Patients, whose airway patency was maintained with laryngeal mask, were divided randomly in two groups. 100% oxygen and 50% oxygen/50% nitrous oxide was used for maintenance of anesthesia in Group I and II, respectively. FLAIR sequence images were analyzed by a radiologist who was unaware of the groups and were evaluated for HSA in 11 different brain regions in cerebrospinal fluid neighborhood. A three-point scale was used for evaluation. Results: HSA was seen in all study patients at least in one brain region. However, no significant difference was obtained between two groups in almost all brain regions (p>0.05). Conclusions: Use of oxygen in pediatric patients undergoing cranial MRI under sevoflurane anesthesia caused a low grade HSA. However, concentration of oxygen had no significant effect on the severity of HSA.

Anahtar Kelimeler

Anesthesia, pediatric, brain, magnetic resonance imaging, cerebrospinal fluid, oxygen

Does oxygen use during general anesthesia cause an artifact in magnetic resonance images?

Öz

Amaç: Bu çalışmadaki amacımız sevofluran anestezisi altında kraniyal manyetik rezonans görüntüleme (MRG) işlemi uygulanacak pediatrik hastalarda, iki farklı oksijen konsantrasyonunun (%100 ve %50) hiperintens sinyal anomalisine (HSA) olası etkilerini karşılaştırmaktır. Gereç ve yöntem: Kraniyal MRG işlemi uygulanan 30 pediatrik hasta üzerinde çalışıldı. MR-uyumlu bir anestezi cihazı ile anestezi indüksiyon ve idamesinde sevofluran kullanıldı. Havayolu açıklığı larengeal maske ile sağlanan hastalar rastgele iki gruba ayrıldı. Anestezi idamesinde Grup I\'de %100 oksijen, Grup II\'de ise %50 oksijen/%50 azot protoksit kullanıldı. FLAIR sekansında elde edilen görüntüler çalışma gruplarına kör bir radyolog tarafından incelenerek beynin 11 ayrı bölgesinde beyin omurilik sıvısında HSA değerlendirildi. Değerlendirme için üç dereceli bir skala kullanıldı. Bulgular: Çalışmadaki tüm hastalarda beynin en az bir bölgesinde HSA izlendi. Ancak incelenen beyin alanlarının tamamına yakınında her iki grup arasında anlamlı bir fark saptanmadı (p>0,05). Sonuç: Sevofluran anestezisi altında kraniyal MRG işlemi uygulanacak pediatrik hastalarda oksijen kullanımı, düşük derecede de olsa HSA\'ya neden oldu. Ancak kullanılan oksijen konsantrasyonunun HSA derecesine anlamlı bir etkisi saptanmadı.

Anahtar Kelimeler

Anestezi, pediatrik, beyin, manyetik rezonans görüntüleme, serebrospinal sıvı, oksijen

Kaynakça

• Wachtel RE, Dexter F, Dow AJ. Growth rates in pedi- atric diagnostic imaging and sedation. Anesth Analg 2009;108(5):1616-21.
• Bozzao A, Floris R, Fasoli F, Fantozzi LM, Colonnese C, Simonetti G. Cerebrospinal fluid changes after in- travenous injection of gadolinium chelate: assessment by FLAIR MR imaging. Eur Radiol 2003;13(3):592-7.
• Singer MB, Atlas SW, Drayer BP. Subarachnoid space disease: diagnosis with fluid-attenuated inversion re- covery MR imaging and comparison with gadolinium- enhanced spin-echo MR imaging - blinded reader study. Radiology 1998;208(2):417-22.
• Singh SK, Agris JM, Leeds NE, Glinsberg LE. Intracra- nial leptomeningeal metastases: comparison of de- piction at FLAIR and contrast-enhanced MR imaging. Radiology 2000;217(1):50-3.
• Tsuchiya K, Katase S, Yoshino A, Hachiya J. FLAIR MR imaging for diagnosing intracranial meningeal carci- nomatosis. AJR Am J Roentgenol 2001;176(6):1585- 8.
• Filippi CG, Uluğ AM, Lin D, Heier LA, Zimmerman RD. Hyperintense signal abnormality in subarachnoid spaces and basal cisterns on MR images of children anesthetized with propofol: new fluid-attenuated in- version recovery finding. AJNR Am J Neuroradiol 2001;22(2):394-9.
• Deliganis AV, Fisher DJ, Lam AM, Maravilla KR. Cere- brospinal fluid signal intensity increase on FLAIR MR images in patients under general anesthesia: the role of supplemental O2. Radiology 2001;218(1):152-6.
• Frigon C, Jardine DS, Weinberger E, Heckbert SR, Shaw DWW. Fraction of inspired oxygen in relation to cerebrospinal fluid hyperintensity on FLAIR MR imag- ing of the brain in children and young adults undergo- ing anesthesia. AJR 2002;179(3):791-6.
• Braga FT, da Rocha AJ, Filho GH, et al. Relationship between the concentration of supplemental oxygen and signal intensity of CSF depicted by fluid-attenuat- ed inversion recovery imaging. AJNR Am J Neurora- diol 2003;24(9):1863-8.
• Anzai Y, Ishikawa M, Shaw DWW, Artru A, Yarnykh V, Maravilla KR. Paramagnetic effect of supplemental oxygen on CSF hyperintensity on fluid-attenuated in- version recovery MR images. AJNR Am J Neuroradiol 2004;25(2):274-9.
• Frigon C, Shaw DWW, Heckbert SR, Weinberger E, Jardine DS. Supplemental oxygen causes increased signal intensity in subarachnoid cerebrospinal fluid on brain FLAIR MR images obtained in children during general anesthesia. Radiology 2004;233(1):51-5.
• Goetz GF, Hecker H, Haeseler G, Becker H, Münte S. Hyperintense cerebrospinal fluid on FLAIR images induced by ventilation with 100% oxygen. Clin Neuro- radiol 2007;17(2):108-15.
• Mitchell P, Wilkinson ID, Hoggard N, et al. Detec- tion of subarachnoid haemorrhage with magnetic resonance imaging. J Neurol Neurosurg Psychiatry 2001;70(2):205-11.
• Mohamed M, Heasely DC, Yagmurlu B, Yousem DM. Fluid-attenuated inversion recovery MR imaging and subarachnoid hemorrhage: not a panacea. AJNR Am J Neuroradiol 2004;25(4):545-50.
• Noguchi K, Ogawa T, Seto H, et al. Subacute and chronic subarachnoid hemorrhage: diagnosis with fluid-attenuated inversionrecovery MR imaging. Radi- ology 1997;203(1):257-62.
• Noguchi K, Ogawa T, Inugami A, et al. Acute sub- arachnoid hemorrhage: MR imaging with fluid-atten- uated inversion-recovery pulse sequences. Radiology 1995;196(3):773-7.
• Işık B. Manyetik rezonans görüntüleme ve anestezi. Marmara Medical Journal 2006;19(2);98-103.
• Marcar VL, Schwarz U, Martin E, Loenneker T. How depth of anesthesia Influences the blood oxygenation level-dependent signal from the visual cortex of chil- dren. AJNR Am J Neuroradiol 2006;27(4):799-805.
• Qiu M, Ramani R, Swetye M, Rajeevan N, Constable RT. Anesthetic effects on regional CBF, BOLD, and the coupling between task-induced changes in CBF and BOLD: An fMRI study in normal human subjects. Magn Reson Med 2008;60(4):987-96.
• Hekimoğlu A. Terapötik gazlar: oksiken, karbondioksit, nitrik oksid ve helyum. Dicle Tıp Derg 2007;34(1):61- 69.
• Stuckey SL, Goh TD, Heffernan T, Rowan D. Hyperin- tensity in the subarachnoid space on FLAIR MRI. AJR 2007;189(4):913-21.
• Dawidowicz AL, Fijalkowska A, Nestorowicz A, Kali- tynski R, Trojanowski T. Cerebrospinal fluid and blood propofol concentration during total intravenous anaes- thesia for neurosurgery. Brit J Anaesth 2003;90(1):84- 90.
• Engdahl O, Abrahams M, Björnsson A, et al. Cerebro- spinal fluid concentrations of propofol during anesthe- sia in humans. Brit J Anaesth 1998;81(6):957-9.
• Acar HV, Çakır O, Özkan S, ve ark. Pediatrik MR se- dasyonu için kullanılan propofol görüntü artefaktı ya- ratır mı? XXXV. Türk Anesteziyoloji ve Reanimasyon Kongresi Özet Kitapçığı, 2002, 110-111.
• Taoka T, Yuh WTC, White ML, Quets JP, Maley JE, Ueda T. Sulcal hyperintensity on fluid-attenuated inversion recovery MR images in patients with- out apparent cerebrospinal fluid abnormality. AJR 2001;176(2):519-24.
• Melhem ER, Jara H, Eustace S. Fluid-attenuated in- version recovery MR imaging: Identification of protein concentration thresholds for CSF hyperintensity. AJR 1997; 169(3):859-62.
• Woodcook RJ Jr, Short J, Do HM, Jensen ME, Kallmes DF. Imaging of acute subarachnoid hemorrhage with a fluid-attenuated inversion recovery sequence in an animal model: comparison with non-contrastenhanced CT. AJNR Am J Neuroradiol 2001;22(9):1698-703.