From the Guidelines
MRI NOVA is a valuable diagnostic tool for visualizing venous structures in the brain and orbit without the need for contrast agents, making it an ideal choice for patients with kidney problems or allergies to contrast media. When considering the use of MRI in monitoring and prognostic tasks, particularly in conditions like multiple sclerosis, it's essential to understand the role of advanced imaging techniques like MRI NOVA. According to the MAGNIMS consensus guidelines on the use of MRI in multiple sclerosis 1, MRI techniques can be used for regular monitoring to help stage patients with MS and measure disease progression. While the guidelines primarily focus on the use of MRI in multiple sclerosis, the principles of utilizing MRI for disease monitoring and prognostication can be applied broadly, including the use of specialized techniques like NOVA for specific conditions. Key points to consider when using MRI NOVA include:
- The technique's ability to provide detailed images of venous anatomy without the use of gadolinium-based contrast agents, reducing risks associated with contrast exposure 1.
- Its utility in diagnosing and monitoring conditions such as venous thrombosis, stenosis, or vascular malformations in the brain and orbital regions.
- The importance of patient preparation, including the removal of all metal objects before the scan, to ensure safety and image quality.
- The potential for MRI NOVA to be repeated over time without concerns about cumulative contrast exposure, making it beneficial for long-term monitoring of venous conditions.
From the Research
MRI Technology and Safety
- Magnetic Resonance Imaging (MRI) technology has become an indispensable imaging tool due to significant improvements in MRI, opening up new diagnostic perspectives 2.
- MRI is a source of potential hazards with various risks, including those associated with electromagnetic fields used for imaging, and requires sound knowledge of physical principles and associated safety risks to avoid adverse events 3.
- Understanding the principles underlying MRI and its multiple applications can appreciate the benefits and limitations of its use, further informing clinical decision-making 4.
Sedation Practices in MRI
- Sedation is often required for MRI examinations due to the closed environment, long imaging time, and need to remain still during the procedure, which can be challenging, especially in special populations 2.
- Traditional sedative drugs, such as midazolam and ketamine, are still used despite their low sedation success rate, prolonged recovery, and significant adverse events 2.
- Currently, dexmedetomidine, propofol, and sevoflurane are preferred for sedation/anesthesia in children and adults undergoing MRI due to their effectiveness and safety profiles 2, 5.
- A standard sedation protocol in MRI centers is associated with a more appropriate drug choice, as well as optimized monitoring and post-procedure care 6.
Sedation Regimens for Children Undergoing MRI
- A regimen with propofol bolus and dexmedetomidine infusion provided adequate sedation and better recovery characteristics in children aged 2-12 years without systemic complications, compared to the use of either agent alone 5.
- Recovery characteristics, such as time to recovery and emergence delirium scores, were significantly improved with the combination regimen compared to dexmedetomidine alone 5.
- The use of a combination regimen can allow for faster recovery and minimize adverse events in children undergoing MRI 5.