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Xu SX, Shan XS, Gao JM, Liu HX, Chen WR, Gao SS, Ji FH, Peng K, Wang Q. Effect of esketamine vs dexmedetomidine adjunct to propofol sedation for pediatric 3Tesla magnetic resonance imaging: a randomized, double-blind, controlled trial. Eur J Med Res 2022; 27:258. [PMID: 36411479 PMCID: PMC9677669 DOI: 10.1186/s40001-022-00890-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/07/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Adequate sedation is essential for pediatric patients undergoing 3Tesla (T) magnetic resonance imaging (MRI). Using propofol alone is associated with patient arousing and adverse airway events. This study aimed to assess esketamine vs dexmedetomidine adjunct to propofol sedation for pediatric 3 T MRI. METHODS In this randomized, double-blind, controlled trial, 114 pediatric patients aged between 6 months and 8 years were randomly assigned, in a 1:1 ratio, to the esketamine-propofol group or the dexmedetomidine-propofol group. Sedation was provided with esketamine or dexmedetomidine in combination with propofol titration. The primary outcome was the total dose of propofol. Secondary outcomes included propofol infusion dose, adverse events, time to emergence from sedation, and time to discharge from recovery room. RESULTS A total of 111 patients completed this study (56 in the esketamine-propofol group and 55 in the dexmedetomidine-propofol group). All MRI procedures were successfully performed under sedation. The total median (IQR) dose of propofol was significantly lower in the esketamine-propofol group (159.8 [121.7, 245.2] μg/kg/min) than that in the dexmedetomidine-propofol group (219.3 [188.6, 314.8] μg/kg/min) (difference in medians [95% CI] = - 66.9 [- 87.8 to - 43.0] μg/kg/min, P < 0.0001). The use of esketamine resulted in a lower dose of propofol for titration (difference in medians [95% CI] = - 64.3 [- 75.9 to - 51.9] μg/kg/min), a shorter time to emergence (difference in means [95% CI] = - 9.4 [- 11.4 to - 7.4] min), and a reduced time to recovery room discharge (difference in means [95% CI] = - 10.1 [- 12.1 to - 8.2] min). In the dexmedetomidine-propofol group, 2 patients experienced upper airway obstruction and 6 patients had bradycardia. No episodes of oxygen desaturation or other adverse events were observed. CONCLUSIONS Although both regimens provided effective sedation for pediatric 3 T MRI, the esketamine-propofol sedation reduced propofol requirement and facilitated recovery, without detection of increased adverse effects in the studied population. Trial registration Chinese Clinical Trial Registry (identifier: ChiCTR2100048477).
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Affiliation(s)
- Shang-xian Xu
- grid.452253.70000 0004 1804 524XDepartment of Anesthesiology, Children’s Hospital of Soochow University, 92 Zhongnan Steet, Suzhou, Jiangsu China ,grid.429222.d0000 0004 1798 0228Department of Anesthesiology, First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006 Jiangsu China ,grid.263761.70000 0001 0198 0694Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu China
| | - Xi-sheng Shan
- grid.429222.d0000 0004 1798 0228Department of Anesthesiology, First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006 Jiangsu China ,grid.263761.70000 0001 0198 0694Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu China
| | - Jin-meng Gao
- grid.452253.70000 0004 1804 524XDepartment of Anesthesiology, Children’s Hospital of Soochow University, 92 Zhongnan Steet, Suzhou, Jiangsu China
| | - Hua-xian Liu
- grid.452253.70000 0004 1804 524XDepartment of Anesthesiology, Children’s Hospital of Soochow University, 92 Zhongnan Steet, Suzhou, Jiangsu China
| | - Wei-rong Chen
- grid.452253.70000 0004 1804 524XDepartment of Anesthesiology, Children’s Hospital of Soochow University, 92 Zhongnan Steet, Suzhou, Jiangsu China
| | - Shan-shan Gao
- grid.452253.70000 0004 1804 524XDepartment of Anesthesiology, Children’s Hospital of Soochow University, 92 Zhongnan Steet, Suzhou, Jiangsu China
| | - Fu-hai Ji
- grid.429222.d0000 0004 1798 0228Department of Anesthesiology, First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006 Jiangsu China ,grid.263761.70000 0001 0198 0694Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu China
| | - Ke Peng
- grid.429222.d0000 0004 1798 0228Department of Anesthesiology, First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006 Jiangsu China ,grid.263761.70000 0001 0198 0694Institute of Anesthesiology, Soochow University, Suzhou, Jiangsu China
| | - Qian Wang
- grid.452253.70000 0004 1804 524XDepartment of Anesthesiology, Children’s Hospital of Soochow University, 92 Zhongnan Steet, Suzhou, Jiangsu China
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Gopinath G, Aslam M, Anusha P. Role of Magnetic Resonance Perfusion Imaging in Acute Stroke: Arterial Spin Labeling Versus Dynamic Susceptibility Contrast-Enhanced Perfusion. Cureus 2022; 14:e23625. [PMID: 35494896 PMCID: PMC9049761 DOI: 10.7759/cureus.23625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction: The role of perfusion neuroimaging in managing cases of acute ischemic stroke (AIS) is to identify ischemic penumbra and regions of hypo-perfusion, which can be salvaged. Dynamic susceptibility contrast (DSC) perfusion imaging techniques have been the main magnetic resonance imaging (MRI) perfusion techniques used to identify AIS. Arterial spin labelling (ASL) is an alternative non-invasive perfusion technique, which permits tissue perfusion measurement without any need for administration of exogenous contrast agents. The objective was to compare the diagnostic accuracy of ASL perfusion MRI versus DSC enhanced perfusion MRI in detecting perfusion-diffusion mismatch of varying volumes in acute ischemic stroke. Materials and methods: A hospital-based observational cross-sectional study was done in a tertiary care institute in Tamil Nadu between December 2018 to October 2019. Fifty-five subjects aged more than 18 years referred to the Radio-diagnosis department (less than 24 hours since the onset of weakness) for emergency assessment of suspected acute stroke were subjected to MRI stroke scan protocol. Then AIS cases were evaluated with ASL and DSC perfusion-weighted imaging. The collected data was entered in Excel (Microsoft, Redmond, WA, USA). IBM SPSS version 22 (IBM Corp., Armonk, NY, USA) was used for statistical analysis. Receiver operating characteristic (ROC) analysis was done to assess the predictive validity of ASL in predicting DSC mismatch. The diagnostic accuracy of ASL was the primary outcome variable. P-value < 0.05 was considered statistically significant. Results: Forty-four subjects confirmed as stroke were included in the final analysis. Their mean (±SD) age was 53.84 (±10.80) years. 72.7% were males. The majority (53.8%) presented during the acute stage of cerebral infarction (53.8%). The majority (45.5%) had hemiplegia followed by aphasia (27.3%). The major vascular territory involved was the middle cerebral artery (54.5%). The sensitivity, specificity, positive predictive value, and negative predictive value of ASL (non-contrast) in predicting DSC (contrast) mismatch was found to be 71.43%, 78.57%, 83.33%, and 64.71% respectively. Conclusion: ASL MR has the potential to replace MRI DSC perfusion in the future imaging diagnostic work-up for stroke. However, further studies are required to validate its role as the first-line imaging for stroke therapy.
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Switlyk MD. Magnetic resonance imaging for assessing treatment response in bone marrow metastases. Acta Radiol 2021; 62:483-499. [PMID: 31154803 DOI: 10.1177/0284185119851234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cancer metastasis to bone is a frequent observation in malignancy that may result in complications such as pathological fractures and spinal cord compression. Monitoring treatment effects is the main concern in oncology; however, the evaluation of treatment response in bone is particularly challenging as it lacks well-established criteria. In addition, bone metastases have traditionally been considered non-measurable manifestations of cancer. Magnetic resonance imaging (MRI) is one of the most specific and sensitive methods for imaging skeletal metastases. The aim of this article is to highlight the diagnostic performance of MRI in the treatment monitoring of bone metastases, to review the current literature, and to provide an overview of recommendations for the evaluation of treatment response in bone.
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Affiliation(s)
- Marta D Switlyk
- Department of Radiology, Radiumhospitalet, Oslo University Hospital, Oslo, Norway
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Nell C, Bülow R, Hosten N, Schmidt CO, Hegenscheid K. Reference values for the cervical spinal canal and the vertebral bodies by MRI in a general population. PLoS One 2019; 14:e0222682. [PMID: 31560692 PMCID: PMC6764695 DOI: 10.1371/journal.pone.0222682] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/03/2019] [Indexed: 01/21/2023] Open
Abstract
Purpose To provide population-based reference values for cervical spinal canal parameters and vertebral body (VB) width and to study their associations with sex, age, body height, body weight and body mass index (BMI) using MRI. Methods Cross-sectional analyses included data from 2,453 participants, aged 21–89 years, of the population-based Study of Health in Pomerania (SHIP) who underwent whole-body MRI at 1.5 Tesla between July 2008 and March 2011. A standardised reading was performed for the C2-C7 cervical spine levels at sagittal T2 TSE weighted sequences. Results Reference intervals for spinal canal parameters were similar in males and females, while VB width was on average 2.1–2.2 mm larger in males. Age effects were only substantial regarding VB width with a 0.5 mm per ten-year age increase. Body height effects were only substantial regarding the osseous spinal canal and VB width. Body weight and BMI effects are mostly not substantial. Conclusions Our study provides MRI-based reference values for the cervical spinal canal parameters in an adult Caucasian population. Except for VB width, associations with sex, age and somatometric measures are mostly small and thus have only limited clinical implications. Some available cut-off values may need a revision because they likely overestimate risks.
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Affiliation(s)
- Christopher Nell
- Department of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Mecklenburg-Western Pomerania, Germany
- * E-mail:
| | - Robin Bülow
- Department of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Mecklenburg-Western Pomerania, Germany
| | - Norbert Hosten
- Department of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Mecklenburg-Western Pomerania, Germany
| | - Carsten Oliver Schmidt
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Mecklenburg-Western Pomerania, Germany
| | - Katrin Hegenscheid
- Department of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Mecklenburg-Western Pomerania, Germany
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