Should Intravenous Contrast be Administered in MRI Evaluation of Pediatric Outpatients with XXXX ?

@entity1 @entity8721 @entity600 @entity76 @entity2794
BACKGROUND: The practice of administering intravenous contrast to @entity1 varies by institution depending on their routine. OBJECTIVES: To assess the necessity of routine contrast administration in brain magnetic resonance imaging (MRI) of pediatric outpatients referred for @entity2794 workups. METHODS: We conducted a retrospective review of consecutive pediatric brain MRI examinations performed during January and February 2014 in 30 pediatric outpatients referred for evaluation of @entity2794 . Independent review was performed by two board-certified neuroradiologists. The raters reviewed each MRI first as a non-contrast examination (without seeing the post-contrast images) and then with post-contrast images. RESULTS: No abnormalities were found in six @entity1 . One @entity1 had an indeterminate finding of a @entity76 requiring follow-up. In the remaining @entity1 (n = 23), the findings were subclinical and included: mucosal thickening in the paranasal sinuses in 9 @entity1 , cystic changes of the pineal gland in 8 (size 2-9 mm), small @entity600 in 6, non-specific FLAIR hyperintensities in 4, opacification of the mastoids in 2, and @entity8721 in 1 @entity1 . The subclinical cases that were missed on pre-contrast images were: one small @entity600 , one @entity8721 and one small pineal cyst, none of which hold clinical significance. All kappa inter-rater and intra-rater agreement scores resulted in values above 0.75, excellent agreement according to Fleiss guidelines. CONCLUSIONS: There seems to be little reason to medically justify large-scale use of routine IV contrast administration to evaluate a brain MRI of pediatric @entity1 referred for @entity2794 .
