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Courtman M, Kim D, Wit H, Wang H, Sun L, Ifeachor E, Mullin S, Thurston M. Deep Learning Detection of Aneurysm Clips for Magnetic Resonance Imaging Safety. JOURNAL OF IMAGING INFORMATICS IN MEDICINE 2024; 37:72-80. [PMID: 38343241 DOI: 10.1007/s10278-023-00932-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/03/2023] [Accepted: 10/19/2023] [Indexed: 03/02/2024]
Abstract
Flagging the presence of metal devices before a head MRI scan is essential to allow appropriate safety checks. There is an unmet need for an automated system which can flag aneurysm clips prior to MRI appointments. We assess the accuracy with which a machine learning model can classify the presence or absence of an aneurysm clip on CT images. A total of 280 CT head scans were collected, 140 with aneurysm clips visible and 140 without. The data were used to retrain a pre-trained image classification neural network to classify CT localizer images. Models were developed using fivefold cross-validation and then tested on a holdout test set. A mean sensitivity of 100% and a mean accuracy of 82% were achieved. Predictions were explained using SHapley Additive exPlanations (SHAP), which highlighted that appropriate regions of interest were informing the models. Models were also trained from scratch to classify three-dimensional CT head scans. These did not exceed the sensitivity of the localizer models. This work illustrates an application of computer vision image classification to enhance current processes and improve patient safety.
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Affiliation(s)
- Megan Courtman
- Faculty of Science and Engineering, School of Engineering, Computing and Mathematics, University of Plymouth, Plymouth, PL4 8AA, UK.
| | - Daniel Kim
- Department of Radiology, Royal Cornwall Hospitals NHS Trust, Truro, TR1 3LJ, UK
| | - Huub Wit
- Department of Radiology, Torbay and South Devon NHS Trust, Torquay, TQ2 7AA, UK
| | - Hongrui Wang
- Department of Radiology, University Hospitals Plymouth NHS Trust, Plymouth, PL6 8DH, UK
| | - Lingfen Sun
- Faculty of Science and Engineering, School of Engineering, Computing and Mathematics, University of Plymouth, Plymouth, PL4 8AA, UK
| | - Emmanuel Ifeachor
- Faculty of Science and Engineering, School of Engineering, Computing and Mathematics, University of Plymouth, Plymouth, PL4 8AA, UK
| | - Stephen Mullin
- Plymouth Institute of Health and Care Research, University of Plymouth, Plymouth, PL4 8AA, UK
| | - Mark Thurston
- Department of Radiology, University Hospitals Plymouth NHS Trust, Plymouth, PL6 8DH, UK
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Hofman MBM, Lavini C, van der Zwan A, van Pul C, Muller SH, Stam MK, van der Graaf M, Kloeze C, van Nierop BJ, Kappert P, Kuijer JPA. MRI in patients with a cerebral aneurysm clip; review of the literature and incident databases and recommendations for the Netherlands. Phys Med 2024; 117:103187. [PMID: 38016215 DOI: 10.1016/j.ejmp.2023.103187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 11/07/2023] [Accepted: 11/23/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND In the past ferromagnetic cerebral aneurysm clips that are contraindicated for Magnetic Resonance Imaging (MRI) have been implanted. However, the specific clip model is often unknown for older clips, which poses a problem for individual patient management in clinical care. METHODS Literature and incident databases were searched, and a survey was performed in the Netherlands that identified time periods at which ferromagnetic and non-ferromagnetic clip models were implanted. Considering this information in combination with a national expert opinion, we describe an approach for risk assessment prior to MRI examinations in patients with aneurysm clips. The manuscript is limited to MRI at 1.5 T or 3 T whole body MRI systems with a horizontal closed bore superconducting magnet, covering the majority of clinical Magnetic Resonance (MR) systems. RESULTS From the literature a list of ferromagnetic clip models was obtained. The risk of movement or rotation of the clip due to the main magnetic field in case of a ferromagnetic clip is the main concern. In the incident databases records of four serious incidents due to aneurysm clips in MRI were found. The survey in the Netherlands showed that from 2000 onwards, no ferromagnetic clips were implanted in Dutch hospitals. DISCUSSION Recommendations are provided to help the MR safety expert assessing the risks when a patient with a cerebral aneurysm clip is referred for MRI, both for known and unknown clip models. This work was part of the development of a guideline by the Dutch Association of Medical Specialists.
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Affiliation(s)
- Mark B M Hofman
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1118, 1081 HV Amsterdam, the Netherlands.
| | - Cristina Lavini
- Department of Radiology and Nuclear Medicine, Amsterdam UMC location AMC, de Boelelaan 1118, 1081 HV Amsterdam, the Netherlands
| | - Albert van der Zwan
- Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, Heidelberglaan 100, Utrecht, the Netherlands
| | - Carola van Pul
- Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, the Netherlands
| | - Sara H Muller
- Maxima Medical Centre, Ds. Th. Fliednerstraat 1, 5631 BM Eindhoven, the Netherlands
| | - Mette K Stam
- Department of Radiology, LUMC, Albinusdreef 2, 2333 ZA Leiden, the Netherlands
| | - Marinette van der Graaf
- Department of Medical Imaging, Radboud UMC, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - Carla Kloeze
- Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, the Netherlands
| | - Bastiaan J van Nierop
- Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands
| | - Peter Kappert
- Department of Radiology, UMCG, Hanzeplein 1, 9713 GZ Groningen, the Netherlands
| | - Joost P A Kuijer
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1118, 1081 HV Amsterdam, the Netherlands
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Senger S, Fischer G, Mühl-Benninghaus R, Backens M, Reisel JR, Fritz T, Brack A, Reith W, Oertel J. Development and Evaluation of an MRI Artifact-Free Aneurysm Clip. Oper Neurosurg (Hagerstown) 2023:01787389-990000000-01002. [PMID: 38112448 DOI: 10.1227/ons.0000000000001031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/24/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND AND OBJECTIVES The digital subtraction angiography is still the gold standard in the follow-up after aneurysm surgery, although it remains a repeating invasive technique with accumulating X-ray exposure. An alternative magnetic resonance angiography has the disadvantage of metal-related artifacts. A metal-free aneurysm clip could overcome this problem. Recent advances in manufacturing technologies of fiber-reinforced plastics might allow developing a prototype of a metal-free clip. METHODS The prototype was formed out of carbon fiber-reinforced polyetheretherketone (CF-PEEK) in accordance with the standard clip design. In vivo and in vitro studies were performed to analyze the central nervous system biocompatibility. The prototype was tested in a phantom in a 3 T MRI scanner and microtomography scanner. For in vivo assessment, the left renal artery of rats was either ligated with a suture, clipped with a regular titanium clip or with the CF-PEEK prototype clip. The animals underwent standard MRI sequences and magnetic resonance angiography and assessment by a blinded neuroradiologist. RESULTS Phantom studies showed no signs of artifacts. The prototype showed a reliable clamping and reopening after clip application, although the clamping force was reduced. In vivo studies showed a successful occlusion of the renal artery in all cases in the magnetic resonance angiography. Clip artifacts were statistically significant reduced in the prototype group (P < .01). CF-PEEK showed no signs of impaired biocompatibility compared with the titanium samples in vitro and in vivo. CONCLUSION Former attempts of metal-free aneurysm clips did not meet the criteria of the standard clip design. In this study, the practicability of this new CF-PEEK artifact-free aneurysm clip has been proven. The further fabrication developments should overcome the problem of a reduced clamping force in the future. After clinical approval, it will improve the magnetic resonance image quality and might help to reduce the amount of digital subtraction angiography in the follow-up.
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Affiliation(s)
- Sebastian Senger
- Department of Neurosurgery, Medical School Saarland University, Homburg, Germany
| | - Gerrit Fischer
- Department of Neurosurgery, Medical School Saarland University, Homburg, Germany
| | | | - Martin Backens
- Department of Neuroradiology, Medical School Saarland University, Homburg, Germany
| | - Jan René Reisel
- Department of Neurosurgery, Medical School Saarland University, Homburg, Germany
| | - Tobias Fritz
- Department for Trauma, Hand and Reconstructive Surgery, Saarland University Medical Center, Homburg, Germany
| | - Alexander Brack
- Fraunhofer Institute for Production Technology IPT, Aachen, Germany
| | - Wolfgang Reith
- Department of Neuroradiology, Medical School Saarland University, Homburg, Germany
| | - Joachim Oertel
- Department of Neurosurgery, Medical School Saarland University, Homburg, Germany
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Stillman M, Chandonnet N, Davis L, Buzan R, Wirecki T. Deep transcranial magnetic stimulation in patients with intracranial aneurysm clips: A case report and guidelines for clinicians. Brain Stimul 2019; 13:273-274. [PMID: 31636021 DOI: 10.1016/j.brs.2019.10.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/10/2019] [Indexed: 11/16/2022] Open
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Walker BJ, Cox BL, Cikla U, de Bellefon GM, Rankouhi B, Steiner LJ, Mahadumrongkul P, Petry G, Thevamaran M, Swader R, Kuo JS, Suresh K, Thoma D, Eliceiri KW. An Investigation Into the Challenges of Using Metal Additive Manufacturing for the Production of Patient-Specific Aneurysm Clips. J Med Device 2019. [DOI: 10.1115/1.4043651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Cerebral aneurysm clips are biomedical implants applied by neurosurgeons to re-approximate arterial vessel walls and prevent catastrophic aneurysmal hemorrhages in patients. Current methods of aneurysm clip production are labor intensive and time-consuming, leading to high costs per implant and limited variability in clip morphology. Metal additive manufacturing is investigated as an alternative to traditional manufacturing methods that may enable production of patient-specific aneurysm clips to account for variations in individual vascular anatomy and possibly reduce surgical complication risks. Relevant challenges to metal additive manufacturing are investigated for biomedical implants, including material choice, design limitations, postprocessing, printed material properties, and combined production methods. Initial experiments with additive manufacturing of 316 L stainless steel aneurysm clips are carried out on a selective laser melting (SLM) system. The dimensions of the printed clips were found to be within 0.5% of the dimensions of the designed clips. Hardness and density of the printed clips (213 ± 7 HV1 and 7.9 g/cc, respectively) were very close to reported values for 316 L stainless steel, as expected. No ferrite and minimal porosity is observed in a cross section of a printed clip, with some anisotropy in the grain orientation. A clamping force of approximately 1 N is measured with a clip separation of 1.5 mm. Metal additive manufacturing shows promise for use in the creation of custom aneurysm clips, but some of the challenges discussed will need to be addressed before clinical use is possible.
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Affiliation(s)
- Brandon J. Walker
- Medical Engineering, Morgridge Institute for Research, 330 N. Orchard Street, Madison, WI 53715 e-mail:
| | - Benjamin L. Cox
- Medical Engineering, Morgridge Institute for Research, 330 N. Orchard Street, Madison, WI 53715 e-mail:
| | - Ulas Cikla
- Neurological Surgery, University of Wisconsin, 1111 Highland Avenue, Madison, WI 53705 e-mail:
| | | | - Behzad Rankouhi
- Department of Mechanical Engineering, University of Wisconsin, 1513 University Avenue, Madison, WI 53705 e-mail:
| | - Leo J. Steiner
- Medical Engineering, Morgridge Institute for Research, 330 N. Orchard Street, Madison, WI 53715
- Department of Biomedical Engineering, University of Wisconsin, 1550 Engineering Drive, Madison, WI 53706 e-mail:
| | - Puwadej Mahadumrongkul
- Medical Engineering, Morgridge Institute for Research, 330 N. Orchard Street, Madison, WI 53715
- Department of Mechanical Engineering, University of Wisconsin, 1513 University Avenue, Madison, WI 53706 e-mail:
| | - George Petry
- Medical Engineering, Morgridge Institute for Research, 330 N. Orchard Street, Madison, WI 53715 e-mail:
| | - Mythili Thevamaran
- Grainger Institute for Engineering, 1550 Engineering Drive, Madison, WI 53706 e-mail:
| | - Rob Swader
- Medical Engineering, Morgridge Institute for Research, 330 N. Orchard Street, Madison, WI 53715 e-mail:
| | - John S. Kuo
- Department of Neurosurgery and Mulva Clinic for the Neurosciences, Dell Medical School, University of Texas at Austin, 1701 Trinity Street, Stop Z1500, Austin, TX 78712 e-mail:
| | - Krishnan Suresh
- Department of Mechanical Engineering, University of Wisconsin, 1513 University Avenue, Madison, WI 53706 e-mail:
| | - Dan Thoma
- Grainger Institute for Engineering, 1550 Engineering Drive, Madison, WI 53706 e-mail:
| | - Kevin W. Eliceiri
- Medical Engineering, Morgridge Institute for Research, 330 N. Orchard Street, Madison, WI 53715
- University of Wisconsin, 1111 Highland Avenue, Madison, WI 53705 e-mail:
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Satoh T, Hishikawa T, Hiramatsu M, Sugiu K, Date I. Visualization of Aneurysmal Neck and Dome after Coiling with 3D Multifusion Imaging of Silent MRA and FSE-MR Cisternography. AJNR Am J Neuroradiol 2019; 40:802-807. [PMID: 30948372 DOI: 10.3174/ajnr.a6026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 03/11/2019] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Our aim was to visualize the precise configuration of the aneurysmal neck and dome with/without remnants combined with a coiled dome after coiling treatment for cerebral aneurysms. We developed 3D multifusion imaging of silent MRA and FSE-MR cisternography. MATERIALS AND METHODS We examined 12 patients with 3D multifusion imaging by composing 3D images reconstructed from TOF-MRA, silent MRA, and FSE-MR cisternography. The influence of magnetic susceptibility artifacts caused by metal materials affecting the configuration of the aneurysmal complex with coiling was assessed in a single 3D image. RESULTS In all cases, TOF-MRA failed to depict the aneurysmal neck complex precisely due to metal artifacts, whereas silent MRA delineated the neck and parent arteries at the coiled regions without serious metal artifacts. FSE-MR cisternography depicted the shape of the coiled aneurysmal dome and parent artery complex together with the brain parenchyma. With the 3D multifusion images of silent MRA and FSE-MR cisternography, the morphologic status of the coiled neck and parent arteries was clearly visualized with the shape of the dome in a single 3D image. CONCLUSIONS Silent MRA is a non-contrast-enhanced form of MRA. It depicts the coiled neck complex without serious metal artifacts. FSE-MR cisternography can delineate the shape of the coiled dome. In this small feasibility study, 3D multifusion imaging of silent MRA and FSE-MR cisternography allowed good visualization of key features of coiled aneurysms. This technique may be useful in the follow-up of coiled aneurysms.
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Affiliation(s)
- T Satoh
- From the Department of Neurological Surgery (T.S.), Ryofukai Satoh Neurosurgical Hospital, Fukuyama, Hiroshima, Japan
| | - T Hishikawa
- Department of Neurological Surgery (T.H., M.H., K.S., I.D.), Okayama University Graduate School of Medicine, Okayama, Okayama, Japan
| | - M Hiramatsu
- Department of Neurological Surgery (T.H., M.H., K.S., I.D.), Okayama University Graduate School of Medicine, Okayama, Okayama, Japan
| | - K Sugiu
- Department of Neurological Surgery (T.H., M.H., K.S., I.D.), Okayama University Graduate School of Medicine, Okayama, Okayama, Japan
| | - I Date
- Department of Neurological Surgery (T.H., M.H., K.S., I.D.), Okayama University Graduate School of Medicine, Okayama, Okayama, Japan
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Yoo A, Jou J, Klopfenstein JD, Kattah JC. Focused Neuro-Otological Review of Superficial Siderosis of the Central Nervous System. Front Neurol 2018; 9:358. [PMID: 29892257 PMCID: PMC5985612 DOI: 10.3389/fneur.2018.00358] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 05/02/2018] [Indexed: 12/27/2022] Open
Abstract
Background Infratentorial siderosis (iSS) is a progressive degenerative disorder targeting primarily the cerebellum and cranial nerve eighth; therefore, progressive ataxia and its neuro-otological findings are common. Toxicity from hemosiderin involves selectively vulnerable neurons and glia in these posterior fossa structures. Other neurologic findings may be present, though our focus relates to the cochlea-vestibular cerebellar involvement. Radiographic evidence of siderosis may be the result of recurrent, albeit covert bleeding in the subarachnoid space, or the consequence of an overt post-traumatic or aneurysmal subarachnoid hemorrhage (SAH). The radiographic iSS appearance is identical regardless of the SAH cause. A recent study provides compelling evidence to search and correct possible hemorrhage sources in the spinal canal. The removal of residual existing hemosiderin deposits that may potentially cause clinical symptoms remains as a major therapeutic challenge. Methods We reviewed large data sources and identified salient papers that describe the pathogenesis, clinical and neurotologic manifestations, and the radiographic features of iSS. Results The epidemiology of iSS is unknown. In a recent series, clinically evident iSS was associated with recurrent SAH; by contrast, in a follow-up period ranging from weeks up to 11 years after a monophasic episode of SAH, radiographic siderosis was clinically silent. However, the post-aneurysmal or post-trauma SAH sample size in this single study was small and their observation period relatively short; moreover, the burden of intraneuronal hemosiderin is likely greater with recurrent SAH. There are a few reports of late iSS, several decades after traumatic SAH. A recent report found subjective hearing loss in aneurysmal SAH individuals with radiographic siderosis. Only in recent years, it is safe to perform magnetic resonance imaging (MRI) in post-aneurysmal SAH, because of the introduction of titanium, MRI-compatible aneurysm clips. Conclusion iSS can be associated with significant neurotologic and cerebellar morbidity; the recurrent SAH variant is frequently clinically symptomatic, has a shorter latency and greater neurotologic disability. In these cases, a thorough search and management of a covert source of bleeding may stop clinical progression. The frequency and clinical course of radiographic iSS after traumatic and post-aneurysmal SAH is largely unknown. Detection of radiographic iSS after trauma or aneurysm bleeding suggests that the slower clinical course could benefit from an effective intervention if it became available. The use of cochlear implants is a valid alternative with advanced hearing impairment.
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Affiliation(s)
- Aran Yoo
- University of Illinois College of Medicine, Peoria, IL, United States
| | - Jonathan Jou
- University of Illinois College of Medicine, Peoria, IL, United States
| | - Jeffrey D Klopfenstein
- Department of Neurosurgery, University of Illinois College of Medicine, Peoria, IL, United States
| | - Jorge C Kattah
- Department of Neurology, Illinois Neurologic Institute, University of Illinois College of Medicine, Peoria, IL, United States
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Tsang ACO, Nicholson P, Pereira VM. Nickel-Related Adverse Reactions in the Treatment of Cerebral Aneurysms: A Literature Review. World Neurosurg 2018; 115:147-153. [PMID: 29684517 DOI: 10.1016/j.wneu.2018.04.073] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/10/2018] [Accepted: 04/11/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND Nickel is the most common metal allergen and predominantly affects women. It is also the ubiquitous component in the alloys used to manufacture intracranial devices for aneurysm treatments, including aneurysm clips, self-expanding stents, flow-diverting stents, and endosaccular occlusion devices. Adverse events related to nickel allergy after deployment of such devices are uncommon but can be severe, resulting in dilemmas in the choice of treatment strategies and devices in managing nickel-sensitive patients with intracranial aneurysms. METHODS A literature search was performed in accordance with the PRISMA guidelines to identify studies reporting on nickel-related adverse events in patients being treated for cerebral aneurysm. The materials of the culprit devices, clinical presentation, histological features, and treatments were reviewed. Clinical considerations and management options for nickel allergy patients were evaluated. RESULTS Nickel is a major component of the cobalt alloy used in aneurysm clips and also of nitinol, which is commonly used in flow diverters and intracranial stents. Our literature review identified 9 articles reporting 10 unique cases of nickel-related adverse events after aneurysm treatment. Five of the cases occurred after aneurysm clipping, and the other 5 were attributed to endovascular devices. Two patients presented with dermatologic manifestations and 8 with neurologic manifestations, including cerebral edema and cerebritis. CONCLUSIONS Neurologic complications related to nickel in cerebral aneurysm treatments are rare but remain concern owing to the high prevalence of nickel allergy in the population. Surgeons and interventionists should consider the metal allergy history and its potential clinical significance in managing nickel-allergic patients with aneurysms.
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Affiliation(s)
- Anderson Chun On Tsang
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada; Division of Neurosurgery, Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Hong Kong.
| | - Patrick Nicholson
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Vitor Mendes Pereira
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University of Toronto, Toronto, Ontario, Canada
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Sasao-Takano M, Misumi K, Suzuki M, Kamiya Y, Noguchi I, Kawahara H. Propofol drip infusion anesthesia for MRI scanning: two case reports. Anesth Prog 2013; 60:60-6. [PMID: 23763561 DOI: 10.2344/0003-3006-60.2.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The magnetic resonance imaging (MRI) room is a special environment. The required intense magnetic fields create unique problems with the use of standard anesthesia machines, syringe pumps, and physiologic monitors. We have recently experienced 2 oral maxillofacial surgery cases requiring MRI: a 15-year-old boy with developmental disability and a healthy 5-year-old boy. The patients required complete immobilization during the scanning for obtaining high-quality images for the best diagnosis. Anesthesia was started in the MRI scanning room. An endotracheal intubation was performed after induction with intravenous administration of muscle relaxant. Total intravenous anesthesia via propofol drip infusion (4-7 mg/kg/h) was used during the scanning. Standard physiologic monitors were used during scan pauses, but special monitors were used during scanning. In MRI scanning for oral maxillofacial surgery, general anesthesia, with the added advantage of having a secured airway, is recommended as a safe alternative to sedation especially in cases of patients with disability and precooperative chidren.
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Affiliation(s)
- Mami Sasao-Takano
- Department of Dental Anesthesiology, Tsurumi University School of Dental Medicine, Yokohama, Japan.
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Mamourian A. Magnetic resonance imaging and clips. J Neurosurg 2012; 117:980-1; author reply 981. [PMID: 22998054 DOI: 10.3171/2012.5.jns12925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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