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Supplemental Oxygen Causes Increased Signal Intensity in Subarachnoid Cerebrospinal Fluid on Brain FLAIR MR Images Obtained in Children during General Anesthesia¹

¹ From the Departments of Radiology (D.W.W.S., E.W.) and Anesthesiology (C.F., D.S.J.), University of Washington School of Medicine, Seattle, Wash; and Department of Epidemiology, University of Washington School of Public Health and Community Medicine, Seattle, Wash (S.R.H.). Received August 27, 2003; revision requested November 10; revision received January 14, 2004; accepted February 4. Supported by academic funding from the Department of Anesthesiology at the University of Washington and the use of equipment from the Thermo Respiratory Group. Address correspondence to C.F., Department of Anesthesiology, Montreal Children’s Hospital, 2300 rue Tupper, Montreal, QC, Canada H3H 1P3 (e-mail: chantal.frigon@muhc.mcgill.ca).

PURPOSE: To prospectively test the hypothesis that high levels of the fraction of inspired oxygen (FIO₂) during general anesthesia cause subarachnoid cerebrospinal fluid (CSF) hyperintensity during fluid-attenuated inversion-recovery (FLAIR) magnetic resonance (MR) imaging.

MATERIALS AND METHODS: At brain MR imaging during general anesthesia with propofol, two FLAIR sequences were performed in 20 children with American Society of Anesthesiologists physical status classification system grades of 3 or lower. The first FLAIR sequence was performed with the child breathing 100% oxygen; the second was performed with the child breathing 30% oxygen. CSF signal intensity was quantified on a three-point ordinal scale (0 = hypointense to brain parenchyma, 1 = isointense to brain parenchyma, 2 = hyperintense to brain parenchyma) by a pediatric neuroradiologist who was blinded to the FIO₂ level. The Wilcoxon signed rank test was used to determine if CSF hyperintensity was correlated with FIO₂.

RESULTS: CSF hyperintensity was present in all 20 children (age range, 1.9–16.7 years; 12 children were boys) when the FIO₂ was 100%. The hyperintensity partially or completely disappeared in the basilar cisterns (P < .001) and cerebral sulcal subarachnoid space (P < .001) after FIO₂ was reduced from 100% to 30%.

CONCLUSION: These findings are consistent with the hypothesis that increased arterial oxygen tension and consequently increased CSF PO₂ resulting from administration of high FIO₂ during general anesthesia are responsible for the increased CSF signal intensity noted on brain FLAIR MR images.

© RSNA, 2004

Index terms: Anesthesia • Brain, MR, 10.121413, 10.121415 • Cerebrospinal fluid, MR, 167.121413, 167.121415 • Magnetic resonance (MR), in infants and children, 10.121413, 10.121415, 167.121413, 167.121415 • Oxygen

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