Anesthesia in PET/MRI. Challenges for the Anesthesiologist: A Narrative Review

Abstract

Positron emission tomography magnetic resonance imaging (PET/MRI) is an advanced imaging modality that combines metabolic information obtained from PET with anatomical and functional details obtained from MRI. This hybrid imaging technique offers superior spatial and temporal resolutions, making it invaluable in clinical and research settings. This review explores the considerations and strategies for administering anesthesia during PET/MRI procedures. Key aspects include patient immobilization to minimize motion artifacts, optimization of anesthetic agents and techniques, and maintenance of physiological stability throughout the imaging session. The review also addresses specific physiological and anesthetic necessities that may influence or interfere with the effective functioning of the injected radiotracer. Apart from strategies and protocols that can be adapted for the safe delivery of anesthesia, this review highlights vital aspects of radiation safety for anesthesiologists working in PET/MRI.

Keywords

PET/MRI - anesthesia - radiation safety

• References

• 1 Antoch G, Bockisch A. Combined PET/MRI: a new dimension in whole-body oncology imaging?. Eur J Nucl Med Mol Imaging 2009; 36 (Suppl. 01) S113-S120
• 2 Hoh CK. Clinical use of FDG PET. Nucl Med Biol 2007; 34 (07) 737-742
• 3 Paans AM, van Waarde A, Elsinga PH, Willemsen AT, Vaalburg W. Positron emission tomography: the conceptual idea using a multidisciplinary approach. Methods 2002; 27 (03) 195-207
• 4 Daghighian F, Sumida R, Phelps ME. PET imaging: an overview and instrumentation. J Nucl Med Technol 1990; 18 (01) 5-15
• 5 Reisz JA, Bansal N, Qian J, Zhao W, Furdui CM. Effects of ionizing radiation on biological molecules: mechanisms of damage and emerging methods of detection. Antioxid Redox Signal 2014; 21 (02) 260-292
• 6 Dexter F, Wachtel RE. Scheduling for anesthesia at geographic locations remote from the operating room. Curr Opin Anaesthesiol 2014; 27 (04) 426-430
• 7 Nagaraj C, Joshi RK, Kumar D. et al. Radiation safety for anesthesiologists and other personnel on simultaneous PET/MRI: possible radiation exposure from patients while performing prolonged duration scans. J Neuroanesthesiol Crit Care 2022; 09: 162-167
• 8 Lindholm P, Minn H, Leskinen-Kallio S, Bergman J, Ruotsalainen U, Joensuu H. Influence of the blood glucose concentration on FDG uptake in cancer: a PET study. J Nucl Med 1993; 34 (01) 1-6
• 9 Boellaard R, O'Doherty MJ, Weber WA. et al. FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0. Eur J Nucl Med Mol Imaging 2010; 37 (01) 181-200
• 10 Delbeke D, Coleman RE, Guiberteau MJ. et al. Procedure guideline for tumor imaging with ¹⁸F-FDG PET/CT 1.0. J Nucl Med 2006; 47 (05) 885-895
• 11 Heinke W, Schwarzbauer C. In vivo imaging of anaesthetic action in humans: approaches with positron emission tomography (PET) and functional magnetic resonance imaging (fMRI). Br J Anaesth 2002; 89 (01) 112-122
• 12 Wilson SR, Shinde S, Appleby I. et al. Guidelines for the safe provision of anaesthesia in magnetic resonance units 2019: Guidelines from the Association of Anaesthetists and the Neuro Anaesthesia and Critical Care Society of Great Britain and Ireland. Anaesthesia 2019; 74 (05) 638-650
• 13 Kaplan E, Daka A, Weissbach A. et al. Triclofos sodium for pediatric sedation in non-painful neurodiagnostic studies. Paediatr Drugs 2019; 21 (05) 371-378
• 14 Machata AM, Willschke H, Kabon B, Kettner SC, Marhofer P. Propofol-based sedation regimen for infants and children undergoing ambulatory magnetic resonance imaging. Br J Anaesth 2008; 101 (02) 239-243
• 15 Jung SM. Drug selection for sedation and general anesthesia in children undergoing ambulatory magnetic resonance imaging. Yeungnam Univ J Med 2020; 37 (03) 159-168
• 16 Schmitz A, Weiss M, Kellenberger C. et al. Sedation for magnetic resonance imaging using propofol with or without ketamine at induction in pediatrics: a prospective randomized double-blinded study. Paediatr Anaesth 2018; 28 (03) 264-274
• 17 Siddappa R, Riggins J, Kariyanna S, Calkins P, Rotta AT. High-dose dexmedetomidine sedation for pediatric MRI. Paediatr Anaesth 2011; 21 (02) 153-158
• 18 Lepeltier H, Lepetit A, Gauberti M. et al. Dexmedetomidine sedation vs. inhaled general anesthesia for pediatric MRI: a retrospective cohort study—dexmedetomidine sedation vs. inhaled general anesthesia for MRI. Arch Pediatr 2022; 29 (03) 213-218
• 19 Jackson TJ, Dawes D, Ahmad S, Martin D, Gyamtso C. Dexmedetomidine improves success of paediatric MRI sedation. Arch Dis Child 2022; 107 (07) 692-694
• 20 Ramaprasannakumar SK, Bhadrinarayan V, Venkataramaiah S. The effectiveness of three regimens of sedation for children undergoing magnetic resonance imaging: a clinical study. Anesth Essays Res 2022; 16 (03) 345-352
• 21 Arlachov Y, Ganatra RH. Sedation/anaesthesia in paediatric radiology. Br J Radiol 2012; 85 (1019): e1018-e1031
• 22 Lawson GR. Controversy: sedation of children for magnetic resonance imaging. Arch Dis Child 2000; 82 (02) 150-153
• 23 Practice Guidelines for Moderate Procedural Sedation and Analgesia. Practice Guidelines for Moderate Procedural Sedation and Analgesia 2018: A Report by the American Society of Anesthesiologists Task Force on Moderate Procedural Sedation and Analgesia, the American Association of Oral and Maxillofacial Surgeons, American College of Radiology, American Dental Association, American Society of Dentist Anesthesiologists, and Society of Interventional Radiology. Anesthesiology 2018; 128 (03) 437-479
• 24 Aldousari H, Abuhadi N, Izz M. et al. Assessment of external radiation dose rate after ¹⁸F-FDG-PET/CT examination. Egypt J Radiol Nucl Med 2023; 54: 80
• 25 The 2007 Recommendations of the International Commission on Radiological Protection. ICRP publication 103. Ann ICRP 2007; 37 (2–4): 1-332