Julie Harreld MD, Presenter: Nothing to Disclose

Roland Kaddoum MD, Abstract Co-Author: Nothing to Disclose

Rakhee Kisan Sansgiri MBBS, DMRD, Abstract Co-Author: Nothing to Disclose

Mary Edna Parish RN, Abstract Co-Author: Nothing to Disclose

John O Glass MS, Abstract Co-Author: Nothing to Disclose

Zoltan Patay, Abstract Co-Author: Nothing to Disclose

Kathleen J. Helton MD, Abstract Co-Author: Nothing to Disclose

Though the differential effects of intravenous (IV) propofol and inhalational sevoflurane on cerebral perfusion are well known to neurosurgeons and anesthesiologists, studies describing the effects of these agents on calculated MR perfusion parameters are lacking. We retrospectively reviewed dynamic susceptibility MR perfusion imaging (DSC MRP) and sedation data in a pediatric neuro-oncology population to investigate the effects of anesthesia on calculated regional cerebral perfusion parameters.

DSC MRP images acquired supratentorially (Magnevist IV contrast, 0.8-1 cc/sec) in 37 pediatric patients without visible supratentorial brain abnormalities (age 1.4 – 18 years, mean 8.6) sedated with IV propofol (n=16), combination sevoflurane and propofol (n=6) or nonsedated (n=15) underwent segmentation of gray and white matter; regional cortical cerebral blood volume (CBV) and cerebral blood flow (CBF) values were then calculated and correlated with age, mean arterial pressure (MAP) and end-tidal CO2 (ETCO2), and statistical comparison made between groups.

Decreases in anterior circulation CBF [anterior (ACA) and middle (MCA) cerebral arteries, p=0.04,p=0.03] with IV propofol were attenuated by the addition of inhalational sevoflurane. Combination IV/Inhalational anesthesia resulted in significantly increased CBF compared to propofol alone in the posterior cerebral artery (PCA) distribution only (p=0.01). Though overall increases in CBV with IV propofol were not significant, the addition of sevoflurane significantly increased MCA (p=0.04) and PCA (p=0.01) CBV compared to non-sedated patients. Though age and MAP were strongly correlated overall, there was no significant correlation in subgroups or with calculated perfusion parameters. ETCO2 was moderately correlated with PCA CBF in the IV group (r2=0.37); correlations were otherwise weak or nonexistent.

Sevoflurane and/or propofol sedation alters calculated MR perfusion CBF and CBV consistent with established physiologic phenomena. There appear to be differential effects of these agents on the anterior vs. posterior circulation. These alterations may complicate interpretation of MR perfusion data.

Anesthetic agents likely cause significant alterations in calculated MR perfusion parameters, potentially impacting interpretation.

Harreld, J, Kaddoum, R, Sansgiri, R, Parish, M, Glass, J, Patay, Z, Helton, K, Impact of Sedation on Pediatric MR Brain Perfusion Imaging.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11013269.html