Reviewing the process of preparing children for MRI

The beating heart: artificial intelligence for cardiovascular application in the clinic

Artificial intelligence (AI) integration in cardiac magnetic resonance imaging presents new and exciting avenues for advancing patient care, automating post-processing tasks, and enhancing diagnostic precision and outcomes. The use of AI significantly streamlines the examination workflow through the reduction of acquisition and postprocessing durations, coupled with the automation of scan planning and acquisition parameters selection. This has led to a notable improvement in examination workflow efficiency, a reduction in operator variability, and an enhancement in overall image quality. Importantly, AI unlocks new possibilities to achieve spatial resolutions that were previously unattainable in patients. Furthermore, the potential for low-dose and contrast-agent-free imaging represents a stride toward safer and more patient-friendly diagnostic procedures. Beyond these benefits, AI facilitates precise risk stratification and prognosis evaluation by adeptly analysing extensive datasets. This comprehensive review article explores recent applications of AI in the realm of cardiac magnetic resonance imaging, offering insights into its transformative potential in the field.

Ambulatory sedation for children under 6 years with CHD in MRI and CT

INTRODUCTION

In infants and young children, good image quality in MRI and CT requires sedation or general anesthesia to prevent motion artefacts. This study aims to determine the safety of ambulatory sedation for children with CHD in an outpatient setting as a feasible alternative to in-hospital management.

METHODS

We recorded 91 consecutive MRI and CT examinations of patients with CHD younger than 6 years with ambulatory sedation. CHD diagnoses, vital signs, applied sedatives, and adverse events during or after ambulatory sedation were investigated.

RESULTS

We analysed 91 patients under 72 months (6 years) of age (median 26.0, range 1-70 months; 36% female). Sixty-eight per cent were classified as ASA IV, 25% as ASA III, and 7% as ASA II (American Society of Anesthesiologists Physical Status Classification). Ambulatory sedation was performed by using midazolam, propofol, and/or S-ketamine. The median sedation time for MRI was 90 minutes (range 35-235 minutes) and 65 minutes for CT (range 40-280 minutes). Two male patients (age 1.5 months, ASA II, and age 17 months, ASA IV) were admitted for in-hospital observation due to unexpected severe airway obstruction. The patients were discharged without sequelae after 1 and 3 days, respectively. All other patients were sent home on the day of examination.

CONCLUSION

In infants and young children with CHD, MRI or CT imaging can be performed under sedation in an outpatient setting by a well-experienced team. In-hospital backup should be available for unexpected events.

Leveraging an efficient preparation method into magnetic resonance examinations of young children aged 3-6

PURPOSE

To evaluate the benefits of a multifaceted concept, ANMTE (Appropriate Number of children, appropriate learning Methods, appropriate adaptive Training, and appropriate Encouragement), proposed by our group, in improving the success rate, efficiency and image quality of Magnetic Resonance (MR) examinations for children from 3 to 6 years old.

METHOD

In this study, 150 participants were included from July 2019 to January 2023, including 50 non-sedated children in ANMTE group, 50 in the group with sedative, and 50 in the group with routine preparations. ANMTE refers to appropriate number of children, appropriate learning methods, appropriate adaptive training, and appropriate encouragement, developed by our group for MR examinations of children from 3 to 6 years old. Group differences in success rate, efficiency, and image quality were evaluated across the three groups using Kaplan-Meier, Log-rank and Chi-square test, respectively.

RESULTS

The rates of successful MR examinations were 44/50 (88 %), 45/50 (90 %), and 36/50 (72 %) for ANMTE group, the group with sedatives and the group with routine preparations, respectively (P = 0.03). Image quality of the 3 groups showed no significant group difference (P = 0.067). In terms of the median duration of MR examinations, ANMTE group was comparable to the group with sedative (both were about 10.0 min), but better than the group with routine preparations (16.5 min) (P = 0.024).

CONCLUSION

We demonstrated the feasibility of our comprehensive nursing method ANMTE in MR examinations of young children, similar to the group with sedative at the success rate and image quality as well as the durations of MR examinations. ANMTE has not only better efficiency but also higher safety as it does not require sedative, which could be promising in clinical routine MR examinations for young children aged 3-6 years old.

Testing a Home Solution for Preparing Young Children for an Awake MRI: A Promising Smartphone Application

Thanks to its non-invasive nature and high-resolution imaging capabilities, magnetic resonance imaging (MRI) is a valuable diagnostic tool for pediatric patients. However, the fear and anxiety experienced by young children during MRI scans often result in suboptimal image quality and the need for sedation/anesthesia. This study aimed to evaluate the effect of a smartphone application called COSMO@home to prepare children for MRI scans to reduce the need for sedation or general anesthesia. The COSMO@home app was developed incorporating mini-games and an engaging storyline to prepare children for learning goals related to the MRI procedure. A multicenter study was conducted involving four hospitals in Belgium. Eligible children aged 4-10 years were prepared with the COSMO@home app at home. Baseline, pre-scan, and post-scan questionnaires measured anxiety evolution in two age groups (4-6 years and 7-10 years). Eighty-two children participated in the study, with 95% obtaining high-quality MRI images. The app was well-received by children and parents, with minimal technical difficulties reported. In the 4-6-year-old group (N = 33), there was a significant difference between baseline and pre-scan parent-reported anxiety scores, indicating an increase in anxiety levels prior to the scan. In the 7-10-year-old group (N = 49), no significant differences were observed between baseline and pre-scan parent-reported anxiety scores. Overall, the COSMO@home app proved to be useful in preparing children for MRI scans, with high satisfaction rates and successful image outcomes across different hospitals. The app, combined with minimal face-to-face guidance on the day of the scan, showed the potential to replace or assist traditional face-to-face training methods. This innovative approach has the potential to reduce the need for sedation or general anesthesia during pediatric MRI scans and its associated risks and improve patient experience.

Bridging the translational gap: what can synaptopathies tell us about autism?

Multiple molecular pathways and cellular processes have been implicated in the neurobiology of autism and other neurodevelopmental conditions. There is a current focus on synaptic gene conditions, or synaptopathies, which refer to clinical conditions associated with rare genetic variants disrupting genes involved in synaptic biology. Synaptopathies are commonly associated with autism and developmental delay and may be associated with a range of other neuropsychiatric outcomes. Altered synaptic biology is suggested by both preclinical and clinical studies in autism based on evidence of differences in early brain structural development and altered glutamatergic and GABAergic neurotransmission potentially perturbing excitatory and inhibitory balance. This review focusses on the NRXN-NLGN-SHANK pathway, which is implicated in the synaptic assembly, trans-synaptic signalling, and synaptic functioning. We provide an overview of the insights from preclinical molecular studies of the pathway. Concentrating on NRXN1 deletion and SHANK3 mutations, we discuss emerging understanding of cellular processes and electrophysiology from induced pluripotent stem cells (iPSC) models derived from individuals with synaptopathies, neuroimaging and behavioural findings in animal models of Nrxn1 and Shank3 synaptic gene conditions, and key findings regarding autism features, brain and behavioural phenotypes from human clinical studies of synaptopathies. The identification of molecular-based biomarkers from preclinical models aims to advance the development of targeted therapeutic treatments. However, it remains challenging to translate preclinical animal models and iPSC studies to interpret human brain development and autism features. We discuss the existing challenges in preclinical and clinical synaptopathy research, and potential solutions to align methodologies across preclinical and clinical research. Bridging the translational gap between preclinical and clinical studies will be necessary to understand biological mechanisms, to identify targeted therapies, and ultimately to progress towards personalised approaches for complex neurodevelopmental conditions such as autism.

Effectiveness of training before unsedated MRI scans in young children: a randomized control trial

BACKGROUND

Young children requiring clinical magnetic resonance imaging (MRI) may be given general anesthesia. General anesthesia has potential side effects, is costly, and introduces logistical challenges. Thus, methods that allow children to undergo awake MRI scans are desirable.

OBJECTIVES

To compare the effectiveness of mock scanner training with a child life specialist, play-based training with a child life specialist, and home book and video preparation by parents to allow non-sedated clinical MRI scanning in children aged 3-7 years.

MATERIALS AND METHODS

Children (3-7 years, n=122) undergoing clinical MRI scans at the Alberta Children's Hospital were invited to participate and randomized to one of three groups: home-based preparation materials, training with a child life specialist (no mock MRI), or training in a mock MRI with a child life specialist. Training occurred a few days prior to their MRI. Self- and parent-reported functioning (PedsQL VAS) were assessed pre/post-training (for the two training groups) and pre/post-MRI. Scan success was determined by a pediatric radiologist.

RESULTS

Overall, 91% (111/122) of children successfully completed an awake MRI. There were no significant differences between the mock scanner (89%, 32/36), child life (88%, 34/39), and at-home (96%, 45/47) groups (P=0.34). Total functioning scores were similar across groups; however, the mock scanner group had significantly lower self-reported fear (F=3.2, P=0.04), parent-reported sadness (F=3.3, P=0.04), and worry (F=3.5, P=0.03) prior to MRI. Children with unsuccessful scans were younger (4.5 vs. 5.7 years, P<0.001).

CONCLUSIONS

Most young children can tolerate awake MRI scans and do not need to be routinely anesthetized. All preparation methods tested, including at-home materials, were effective.

Brief mock-scan training reduces head motion during real scanning for children: A growth curve study

Pediatric neuroimaging datasets are rapidly increasing in scales. Despite strict protocols in data collection and preprocessing focused on improving data quality, the presence of head motion still impedes our understanding of neurodevelopmental mechanisms. Large head motion can lead to severe noise and artifacts in magnetic resonance imaging (MRI) studies, inflating correlations between adjacent brain areas and decreasing correlations between spatial distant territories, especially in children and adolescents. Here, by leveraging mock-scans of 123 Chinese children and adolescents, we demonstrated the presence of increased head motion in younger participants. Critically, a 5.5-minute training session in an MRI mock scanner was found to effectively suppress the head motion in the children and adolescents. Therefore, we suggest that mock scanner training should be part of the quality assurance routine prior to formal MRI data collection, particularly in large-scale population-level neuroimaging initiatives for pediatrics.

Factors associated with MRI success in children cooled for neonatal encephalopathy and controls

OBJECTIVE

To investigate if an association exists between motion artefacts on brain MRI and comprehension, co-ordination, or hyperactivity scores in children aged 6-8 years, cooled for neonatal encephalopathy (cases) and controls.

METHODS

Case children (n = 50) without cerebral palsy were matched with 43 controls for age, sex, and socioeconomic status. Children underwent T1-weighted (T1w), diffusion-weighted image (DWI) brain MRI and cognitive, behavioural, and motor skills assessment. Stepwise multivariable logistic regression assessed associations between unsuccessful MRI and comprehension (including Weschler Intelligence Scale for Children (WISC-IV) verbal comprehension, working memory, processing speed and full-scale IQ), co-ordination (including Movement Assessment Battery for Children (MABC-2) balance, manual dexterity, aiming and catching, and total scores) and hyperactivity (including Strengths and Difficulties Questionnaire (SDQ) hyperactivity and total difficulties scores).

RESULTS

Cases had lower odds of completing both T1w and DWIs (OR: 0.31, 95% CI 0.11-0.89). After adjusting for case-status and sex, lower MABC-2 balance score predicted unsuccessful T1w MRI (OR: 0.81, 95% CI 0.67-0.97, p = 0.022). Processing speed was negatively correlated with relative motion on DWI (r = -0.25, p = 0.026) and SDQ total difficulties score was lower for children with successful MRIs (p = 0.049).

CONCLUSIONS

Motion artefacts on brain MRI in early school-age children are related to the developmental profile.

IMPACT

Children who had moderate/severe neonatal encephalopathy are less likely to have successful MRI scans than matched controls. Motion artefact on MRI is associated with lower MABC-2 balance scores in both children who received therapeutic hypothermia for neonatal encephalopathy and matched controls, after controlling for case-status and sex. Exclusion of children with motion artefacts on brain MRI can introduce sampling bias, which impacts the utility of neuroimaging to understand the brain-behaviour relationship in children with functional impairments.

Initial Evidence for Positive Effects of a Psychological Preparation Program for MRI "iMReady" in Children with Neurofibromatosis Type I and Brain Tumors-How to Meet the Patients' Needs Best

To provide an effective alternative to sedation during MRI examinations in pediatric cancer and NF1 patients, the aims of the present study were to (1) exploratively evaluate a behavioral MRI training program, to (2) investigate potential moderators, as well as to (3) assess the patients' well-being over the course of the intervention. A total of n = 87 patients of the neuro-oncology unit (mean age: 6.83 years) underwent a two-step MRI preparation program, including training inside the scanner, and were recorded using a process-oriented screening. In addition to the retrospective analysis of all data, a subset of 17 patients were also analyzed prospectively. Overall, 80% of the children receiving MRI preparation underwent the MRI scan without sedation, making the success rate almost five times higher than that of a group of 18 children that opted out of the training program. Memory, attentional difficulties, and hyperactivity were significant neuropsychological moderators for successful scanning. The training was associated with favorable psychological well-being. These findings suggest that our MRI preparation could present an alternative to sedation of young patients undergoing MRI examinations as well as a promising tool for improving patients' treatment-related well-being.

Comparing Smartphone Virtual Reality Exposure Preparation to Care as Usual in Children Aged 6 to 14 Years Undergoing Magnetic Resonance Imaging: Protocol for a Multicenter, Observer-Blinded, Randomized Controlled Trial

BACKGROUND

A magnetic resonance imaging (MRI) procedure can cause preprocedural and periprocedural anxiety in children. Psychosocial interventions are used to prepare children for the procedure to alleviate anxiety, but these interventions are time-consuming and costly, limiting their clinical use. Virtual reality (VR) is a promising way to overcome these limitations in the preparation of children before an MRI scan.

OBJECTIVE

The objective of this study is (1) to develop a VR smartphone intervention to prepare children at home for an MRI procedure; and (2) to examine the effect of the VR intervention in a randomized controlled trial, in which the VR intervention will be compared to care as usual (CAU). CAU involves an information letter about an MRI examination. The primary outcome is the child's procedural anxiety during the MRI procedure. Secondary outcomes include preprocedural anxiety and parental anxiety. We hypothesize that the VR preparation will result in a higher reduction of the periprocedural anxiety of both parents and children as compared to CAU.

METHODS

The VR intervention provides a highly realistic and child-friendly representation of an MRI environment. In this randomized controlled trial, 128 children (aged 6 to 14 years) undergoing an MRI scan will be randomly allocated to the VR intervention or CAU. Children in the VR intervention will receive a log-in code for the VR app and are sent cardboard VR glasses.

RESULTS

The VR smartphone preparation app was developed in 2020. The recruitment of participants is expected to be completed in December 2022. Data will be analyzed, and scientific papers will be submitted for publication in 2023.

CONCLUSIONS

The VR smartphone app is expected to significantly reduce pre- and periprocedural anxiety in pediatric patients undergoing an MRI scan. The VR app offers a realistic and child-friendly experience that can contribute to modern care. A smartphone version of the VR app has the advantage that children, and potentially their parents, can get habituated to the VR environment and noises in their own home environment and can do this VR MRI preparation as often and as long as needed.

TRIAL REGISTRATION

ISRCTN Registry ISRCTN20976625; https://www.isrctn.com/ISRCTN20976625.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/41080.

Effectiveness of mock scanners and preparation programs for successful magnetic resonance imaging: a systematic review and meta-analysis

This review aimed to summarise the effectiveness of preparation programs for magnetic resonance imaging (MRI) in children using mock scanners and the success rates by systematically reviewing the current literature. We initially identified 67 articles using the search terms "MRI," "mock" and "child" on online databases. All studies involving a preparation programme for MRI on children ages 18 years or younger, healthy children and those with medical diagnoses were included. The authors extracted data on study design, participant data, details of the MRI protocol and the total numbers of patients who underwent preparation programs and were scanned while awake, without sedation or general anesthesia. Twenty-three studies were included in this review. Preparation programs included in-home and hospital/research facility components; these consisted of a mock scanner, explanatory booklets, recorded MRI scan sounds and other educational materials. The success rate of MRI after the preparation programme reported in each study ranged from 40% to 100%. When all participants from studies that specifically assessed the efficacy of preparation programs were combined, participants who underwent a preparation programme (n = 196) were more likely to complete a successful MRI than those who did not undergo a preparation programme (n = 263) (odds ratio [OR] = 1.98). Our results suggest that preparation programs may help reduce the risk of children failing MRI scans.

Key considerations for child and adolescent MRI data collection

Cognitive neuroimaging researchers' ability to infer accurate statistical conclusions from neuroimaging depends greatly on the quality of the data analyzed. This need for quality control is never more evident than when conducting neuroimaging studies with children and adolescents. Developmental neuroimaging requires patience, flexibility, adaptability, extra time, and effort. It also provides us a unique, non-invasive way to understand the development of cognitive processes, individual differences, and the changing relations between brain and behavior over the lifespan. In this discussion, we focus on collecting magnetic resonance imaging (MRI) data, as it is one of the more complex protocols used with children and youth. Through our extensive experience collecting MRI datasets with children and families, as well as a review of current best practices, we will cover three main topics to help neuroimaging researchers collect high-quality datasets. First, we review key recruitment and retention techniques, and note the importance for consistency and inclusion across groups. Second, we discuss ways to reduce scan anxiety for families and ways to increase scan success by describing the pre-screening process, use of a scanner simulator, and the need to focus on participant and family comfort. Finally, we outline several important design considerations in developmental neuroimaging such as asking a developmentally appropriate question, minimizing data loss, and the applicability of public datasets. Altogether, we hope this article serves as a useful tool for those wishing to enter or learn more about developmental cognitive neuroscience.

Interventions and methods to prepare, educate or familiarise children and young people for radiological procedures: a scoping review

Children attending hospital for radiological procedures can experience uncertainty, anxiety and distress; this can result in sub-optimal experiences for children, poor scan quality and the need for radiological procedures to be rescheduled or sedation to be used. The preparation and education of children before clinical procedures has been shown to have a positive influence on procedural outcomes. This scoping review aimed to locate and examine the evidence relating to non-invasive interventions and methods to prepare, educate and familiarise children for radiological procedures within a healthcare setting. A comprehensive search strategy identified 36 articles. A narrative synthesis approach was adopted to make sense of the key findings. Studies investigated a range of radiological procedures (MRI, plain radiographs, CT, fluoroscopy and Micturating cystourethrogram) using a wide range of interventions (smartphone applications, storybooks, videos, mock scanners) which varied by method, mode of delivery and target audience. The outcomes used to evaluate the value and impact of the interventions are wide, varied and inconsistently applied making it difficult to judge which interventions offer the optimal impact on scan quality, scan completion and children’s experiences. This review highlights that there is a need to further understand which specific elements of the non-invasive interventions ‘work best’ for children. There is a need for consistency on the outcomes measured and for these measures to include child-centred outcomes alongside scan quality and length of radiological procedure.

A randomized controlled study: The effect of preprocedurals ınformative animation watch about echocardiography and ıntraprocedural kaleidoscope watch on anxiety in children

AIM

This study was conducted as a randomized controlled study to investigate the effect of procedural cartoons displayed before echocardiography and kaleidoscope display during the procedure on anxiety in children aged 5-12 years.

METHODS

The study was completed with 164 children aged 5-12 years who were admitted for echocardiography. The study was conducted with four groups: cartoons group, kaleidoscope group, cartoons + kaleidoscope group, and control group. Data were collected using a follow-up form and the Children's Fear Scale.

RESULTS

The results showed that the cartoons, kaleidoscope, and cartoons + kaleidoscope groups had lower anxiety scores during the procedure than during the preprocedural period (p < .001). In the control group, there was no significant difference between anxiety scores before the procedure and during the procedure (p > .05).

CONCLUSION

The present study concluded that cartoon display for preparing children aged 5-12 years or distracting them during the procedure using a kaleidoscope was effective in reducing their anxiety.

Development of white matter microstructure and executive functions during childhood and adolescence: a review of diffusion MRI studies

Diffusion magnetic resonance imaging (dMRI) provides indirect measures of white matter microstructure that can be used to make inferences about structural connectivity within the brain. Over the last decade, a growing literature of cross-sectional and longitudinal studies have documented relationships between dMRI indices and cognitive development. In this review, we provide a brief overview of dMRI methods and how they can be used to study white matter and connectivity and review the extant literature examining the links between dMRI indices and executive functions during development. We explore the links between white matter microstructure and specific executive functions: inhibition, working memory and cognitive shifting, as well as performance on complex executive function tasks. Concordance in findings across studies are highlighted, and potential explanations for discrepancies between results, together with challenges with using dMRI in child and adolescent populations, are discussed. Finally, we explore future directions that are necessary to better understand the links between child and adolescent development of structural connectivity of the brain and executive functions.

Autism-friendly MRI: Improving radiography practice in the UK, a survey of radiographer practitioners

INTRODUCTION

Autistic individuals undergoing magnetic resonance imaging (MRI) examinations may face significant challenges, mainly due to sensory overload and MRI environment-related limitations. This study aimed to explore radiographers' perspectives and experiences regarding MRI scanning of autistic individuals.

METHODS

Data collection was achieved using a specifically designed mixed methods questionnaire on Qualtrics. The snowball technique was used. This UK-wide survey was electronically distributed by three main recruitment agencies between December 2020 and February 2021.

RESULTS

130 valid responses were received. A lack of relevant training and knowledge related to autism was noted. Effective communication, optimisation and customisation of the MRI examination, and MRI environment adjustments facilitated the completion of a safe and effective MRI examination. Poor patient-radiographer communication, unavailability of Special Educational Needs (SEN) experts, lack of specialised radiographer training and lack of specific guidelines were identified as the main barriers to successful MRI examinations.

CONCLUSION

Although routine MRI safety and patient care rules will apply, MRI scanning of autistic individuals requires customisation and reasonable adjustments in communication, environment, and training of clinical teams. In addition, guidelines should be established to be used as a reference point to improve clinical practice. The adjustments proposed by radiographers were all consistent with the interventions in the wider literature.

IMPLICATIONS FOR PRACTICE

MRI practice for personalised care of autistic individuals should be aligned with current evidence, to customise communication and offer workflow and environmental adjustments. Formal training related to autism, integrated within radiography academic curricula and better co-ordination and communication of interdisciplinary teams would provide the necessary skill mix to deliver safe, high quality MRI scans with optimal experience for autistic service users and their carer(s).

Effects of dexmedetomidine sedation for magnetic resonance imaging in children: a systematic review and meta-analysis

PURPOSE

Pediatric sedation is commonly required to obtain high-quality images in magnetic resonance imaging (MRI). We performed a systematic review and meta-analysis to assess the effects of dexmedetomidine sedation for MRI in children.

METHODS

A systematic review was conducted to find all randomized controlled trials concerning dexmedetomidine sedation for MRI in children. We searched databases using the Ovid platform in the Cochrane Controlled Trials Register, MEDLINE, and EMBASE. This study was registered in the PROSPERO database: CRD42020198368.

RESULTS

Seven studies and 753 participants were included. Dexmedetomidine sedation showed a significantly delayed onset time [weighted mean differences (WMD) = 8.13 min, 95% confidence interval (CI) 4.64 to 11.63, I² = 98%] and recovery time (WMD = 5.22 min, 95% CI 0.35 to 10.09, I² = 92%) compared to propofol, ketamine, and midazolam sedation. There was no difference in quality of sedation [risk ratio (RR) = 1.25, 95% CI 0.92 to 1.69, I² = 89%], or incidence of sedation failure (RR = 1.39, 95% CI 0.53 to 3.66, I² = 83%) between groups. Although a significantly decreased heart rate (WMD = - 17.34 beats/minute, 95% CI - 22.42 to - 12.26, I² = 96%) was observed, bradycardia that required treatment was not increased (RR = 8.00, 95% CI 1.02 to 62.64, I² = 0%). Dexmedetomidine sedation had a lower incidence of desaturation events (RR = 0.42, 95% CI 0.20 to 0.86, I² = 4%). However, there was no difference in incidence of postoperative vomiting (RR = 0.42, 95% CI 0.15 to 1.17, I² = 17%) between groups.

CONCLUSIONS

Dexmedetomidine sedation provided a similar sedation quality with a reduced incidence of desaturation events. However, the delayed onset and recovery times were drawbacks. The clinical significance of bradycardia is considered to be low. GRADE assessment revealed the quality of the evidence in this meta-analysis ranged from very low to moderate.

Safety challenges related to the use of sedation and general anesthesia in pediatric patients undergoing magnetic resonance imaging examinations

The use of sedation and general anesthesia has facilitated the significant growth of MRI use among children over the last years. While sedation and general anesthesia are considered to be relatively safe, their use poses potential risks in the short term and in the long term. This manuscript reviews the reasons why MRI examinations require sedation and general anesthesia more commonly in the pediatric population, summarizes the safety profile of sedation and general anesthesia, and discusses an amalgam of strategies that can be implemented and can ultimately lead to the optimization of sedation and general anesthesia care within pediatric radiology departments.

Encephalon Mri in 4-12 Years Old Children: How Pain, Fear and Sadness Regulation Affect MRI Image Quality

Magnetic Resonance Imaging is often difficult to conduct, especially in children, because of restricted space, forced immobility, and loud noises. Providing children with adequate and age-appropriate information about the procedurecould reduce the use of anesthesia, the time and cost necessary . This research investigated the emotional regulation skills of children when provided with an information and orientation task before the examination. Analogical scales were used to measure the levels of fear, pleasure, and pain felt by 60 children who were waiting for a brain magnetic Resonance in two hospitals in Milan . Data collection took place at three different junctures; upon children's arrival at the hospital, following their preparation for this experience, and after the examination. Results showed that preparing children for the procedure helped to reduce anxiety and provided a space for them to externalize and self-regulate their emotional experiences. To combine the information strategy with the lived experiences allows the patient to anticipate the examination and to experience it in a simulation context, thus coming to the real examination more prepared and less emotionally activated. Preparation has a positive effect on children of all ages, particularly 4- to 7-year-old's. Moreover, fear regulation is associated with improved Magnetic resonance quality.

An fMRI investigation of neural activation predicting memory formation in children with fetal alcohol spectrum disorders

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Expected brain regions activated during memory formation in FASD and Control children.

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Prenatal alcohol predicted differences in brain activations during memory formation.

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More extensive neural activation during successful memory formation in FAS/PFAS group.

Prenatal alcohol exposure (PAE) is associated with physical anomalies, growth restriction, and a range of neurobehavioral deficits. Although declarative memory impairment has been documented extensively in individuals with fetal alcohol spectrum disorders (FASD), this cognitive process has been examined in only one functional magnetic resonance imaging (fMRI) study, and mechanisms underlying this impairment are not well understood. We used an event-related fMRI design to examine neural activations during visual scene encoding that predict subsequent scene memory in 51 right-handed children (age range = 10–14 years, M = 11.3, SD = 1.3) whose mothers had been recruited and interviewed prospectively about their alcohol use during pregnancy. Following examination by expert dysmorphologists, children were assigned to one of three FASD diagnostic groups: FAS/PFAS (n_FAS = 7; n_PFAS = 4), nonsyndromal heavily exposed (HE; n = 14), and Controls (n = 26). Subsequent memory was assessed in a post-scan recognition test, and subsequent memory activations were examined by contrasting activations during encoding of scenes that were subsequently remembered (hits) to those for incorrectly judged as ‘new’ (misses). Recognition accuracy did not differ between groups. Pooled across groups, we observed extensive bilateral subsequent memory effects in regions including the hippocampal formation, posterior parietal cortex, and occipital cortex—a pattern consistent with previous similar studies of typically developing children. Critically, in the group of children with FAS or PFAS, we observed activations in several additional regions compared to HE and Control groups. Given the absence of between-group differences in recognition accuracy, these data suggest that in achieving similar memory compared to children in the HE and Control groups, children with FAS and PFAS recruit more extensive neural resources to achieve successful memory formation.

Effect of General Anesthesia on Cardiac Magnetic Resonance-Derived Cardiac Function in Repaired Tetralogy of Fallot

Cardiac magnetic resonance imaging (CMR)-derived ejection fraction (EF) predicts adverse outcomes in repaired tetralogy of Fallot (rTOF) and drives timing of pulmonary valve replacement. Certain patient populations require sedation for successful CMR image acquisition. General anesthesia (GA) has been shown to depress EF and heart rate (HR) in animal models, however, its effect on congenital heart disease is unknown. A retrospective review was conducted of all CMR patients referred with rTOF between January 2011 and May 2019. The cohort was separated into GA and non-GA groups. Propensity score matching (PSM) adjusted for selection bias. A kernel matching algorithm was used to match subjects and the differences in mean treatment effect on the treated were computed for left ventricular (LV) and right ventricular (RV) EF, HR, and cardiac index (CI). 143 patients met criteria, 37 patients under GA (mean age 15 years, range 2-45, 59% male), and 106 patients without GA (mean age 21 years, range 10-53, 50% male). Unmatched analysis showed significant depression of LV EF (50 vs. 57%, p < 0.001) and RV EF (42 vs. 48%, p < 0.001) in the GA group compared to the non-GA group. There was no significant difference in HR or CI. After matching and PSM adjustment, the GA group had a significant decrease in LV EF (49 vs. 56%, p < 0.001), RV EF (41 vs. 48%, p < 0.001), CI (2728 vs. 3701 ml/min/m², p < 0.001), and HR (72 vs. 79 bpm, p = 0.04). General anesthesia with sevoflurane results in depressed CMR-derived EF.

A Neuroimaging Preparation Protocol Tailored for Autism

This paper describes the key basic elements required for a successful multi-parametric MRI data acquisition in awake children with autism. The procedure was designed by taking into account methodological challenges arising from the acquisition of Resting State fMRI (RS fMRI) data, and factors such as cost, time, and staff availability. The ultimate aim was to prepare an imaging preparation protocol with high transferability to the whole autism spectrum, adaptable for use in a multi-site research with multiple time points. As part of a randomized pharmaco-intervention study, 31 children aged 4-10 years with Neurofibromatosis 1 and autism underwent MR imaging at baseline and end of intervention. The protocol consisted of tailored habituation instructions including gradual exposure to scanner noise, a social stories booklet, positive incentive strategies, and Play Therapy support. Success rate for initial acquisition was 71% for GABA+ MR spectroscopy at either location, 87% for perfusion, and 67% for diffusion assessment, and 71% for RS fMRI. Qualitative data indicated that 84% parents found the habituation protocol helpful. LAY SUMMARY: Here we describe a protocol for brain Magnetic Resonance Imaging (MRI) tailored for children with ASD to help reduce stress and avoid sedation during scanning. This procedure can make advanced medical imaging more accessible and promote a better MRI experience for families of children with ASD.

The MRI Self-Efficacy Scale for Children: Development and Preliminary Psychometrics

OBJECTIVE

Magnetic resonance imaging (MRI) is a common procedure that can be distressing for children. Although not yet studied in the context of pediatric medical procedures, self-efficacy may be a good predictor of procedural stress and a clinically feasible target for behavioral intervention. The objectives of this study were to develop the MRI Self-Efficacy Scale for Children (MRI-SEC) and assess the preliminary psychometric properties.

METHODS

Development of the MRI-SEC was informed by literature searches and feedback from healthcare providers. Twenty child-parent dyads naïve to MRI and 10 child-parent dyads with MRI experience completed the MRI-SEC to assess the comprehensibility and ease of use, and to inform item and scale refinement. The final version includes four practice items and 12 items directly assessing MRI self-efficacy. To evaluate the psychometric properties, 127 children (ages 6-12) and parents naïve to MRI completed the MRI-SEC, and a series of measures to assess construct validity. To evaluate test-retest reliability 27 children completed the MRI-SEC a second time.

RESULTS

The MRI-SEC demonstrated acceptable internal consistency, test-retest reliability, and convergent validity.

CONCLUSION

Development of the MRI-SEC provides an opportunity to better understand the role of self-efficacy as a predictor of procedural stress and cooperation with MRI, informing reliable prediction of children who may benefit from additional support for MRI and the development of tailored behavioral interventions.

Impact on child and parent anxiety level of a teddy bear-scale mock magnetic resonance scanner

BACKGROUND

Pediatric magnetic resonance imaging (MRI) can be stressful. Mock MR scanners have been proven to be effective in avoiding the use of general anesthesia.

OBJECTIVES

We prospectively evaluated the impact of a teddy bear-scale model of a mock MR scanner on the anxiety experienced by parents and their children during MRI without general anesthesia .

MATERIALS AND METHODS

A 1-year prospective study before and after the installation of a mock scanner in a Pediatric Radiology Department of a university hospital. Anxiety levels were self-estimated by children ages 4 to 16 years and by the parents with a visual analogue scale (from 0, completely relaxed, to 100, extremely stressed) at three moments: in the waiting room, in the preparation room after an explanation by the MRI technologists, and at the issue of the MR acquisition images. Two groups were tested: one with a mock MR scanner, the other without. Analysis of variance (ANOVA) and Fisher exact tests were performed. Motion artifacts were studied.

RESULTS

Ninety-one children and their parents were included. The median age was 8 years (standard deviation [SD]=2). In the post mock period, the ambiance of the preparation room was considered by children as significantly more relaxing in 50% vs. 20% (P=0.004) and the anxiety level of children was significantly lower after the explanation, particularly in girls, but unchanged for their parents. The anxiety levels at the end of the examination were significantly lower for parents. The motion artifacts rate was lower (1.7% vs. 4.7%, P=0.04).

CONCLUSION

A mock scanner was an efficient tool to improve efficiency of the explanation and to decrease anxiety in children and motion artifacts in pediatric MRI.

Individualised MRI training for paediatric neuroimaging: A child-focused approach

Magnetic Resonance Imaging (MRI) in paediatric cohorts is often complicated by reluctance to enter the scanner and head motion-related imaging artefacts. The process is particularly challenging for children with neurodevelopmental disorders where coping with novel task demands in an unfamiliar setting may be more difficult due to symptom-related deficits or distress. These issues often give rise to excessive head motion that can significantly reduce the quality of images acquired, or render data unusable. Here we report an individualised MRI training procedure that enables children with Autism Spectrum Disorders (ASD) to better tolerate the MRI scanner environment based on a child-focused approach and individualised familiarisation strategies, including a pre-visit interview, familiarisation package, and personalised rewards. A medical imaging mobile application was utilised to familiarise participants to multi-sensory aspects of the neuroimaging experience through a variety of themed mini-games and activities. The MRI training procedure was implemented for monozygotic twins (n = 12; 6 twin pairs; age range 7.1–12.9 years) concordant or discordant for ASD. MRI image quality indices were better or comparable to images acquired from a large independent multi-centre ASD cohort. Present findings are promising and suggest that child-focused strategies could improve the quality of paediatric neuroimaging in clinical populations.

Transforming the Imaging Experience While Decreasing Sedation Rates

OBJECTIVE

To evaluate the effect of the MRI-am-a-Hero program on sedation utilization for outpatient pediatric MRI studies.

METHODS

The MRI-am-a-Hero program, which utilizes multimedia educational material and popular comic book characters to educate and support pediatric patients during MRI scan, was implemented at the radiology facility of a single tertiary care, academic medical center. The effect of the MRI-am-a-Hero program on sedation utilization for pediatric MRI was retrospectively evaluated using multivariate regressions yielding odds ratio of sedation before and after program implementation. The institutional review board approved the study with HIPAA compliancy. Effectiveness of the program was evaluated while controlling for age, neurological MRI examination, number of examinations in the case, and use of intravenous contrast. Further analysis was performed in subgroups categorized by age, neurological MRI versus nonneurological MRI, and the use of contrast.

RESULTS

The percent of MRI cases with sedation decreased from 22.9% to 17.3% after the MRI-am-a-Hero program was implemented. When controlling for other variables, including patient age, neurological MRI, number of examinations in a case, and use of intravenous contrast, the odds of a study being performed with sedation after program implementation are 40% less than the odds before program implementation (odds ratio [OR] 0.60, P < .001). The effect of the program was greatest for patients aged 4 to 7 (OR 0.56, P < .001), followed by patients aged 8 to 11 (OR 0.64, P = .019). It was not statistically significant for patients aged 12 to 15 (OR 0.97, P = .919).

CONCLUSION

MRI-am-a-Hero is a generalizable and inexpensive program for reducing sedation utilization for outpatient pediatric MRI studies, especially for patients aged 4 to 11.

Effect of Anesthesia Applied for Magnetic Resonance Imaging on the Body Temperature of Pediatric Patients

Objective Anesthesia may be required to ensure the immobility of the patient during a magnetic resonance imaging (MRI) scan, particularly in pediatric patients. An MRI scanner generates radiofrequency radiation (RFR) to obtain images of parts of the body. During an MRI procedure, an amount of RFR is transformed into heat by the body, thereby leading to increased body temperature. However, patients are at increased risk of hypothermia due to the impairment of thermoregulation by anesthesia and the cold and dry environment of the MRI room. The aim of this study was to investigate the effects of anesthesia on body temperature with regard to patient safety in pediatric patients undergoing an MRI scan. Materials and methods The study included a total of 40 children aged three to 10 years who underwent an MRI procedure. The patients were divided into two groups based on the administration of anesthesia: (I) non-sedated and (II) sedated. Prior to the procedure, non-sedated patients were informed about the procedure by a psychiatrist. Body temperature was measured from the tympanic membrane and skin in each patient. The MRI scan was performed at room temperature (20°C-22°C) with a relative humidity of 35%-40%. Results No significant change was found between pre- and post-scan body temperatures in Group I, whereas a significant decrease was found between pre- and post-scan body temperatures in Group II. No complication occurred in any patient due to temperature change or anesthesia. Conclusion A significant decrease in body temperature was found in pediatric patients undergoing an MRI procedure under sedation. The results implicated that anesthesia has a remarkable effect on the balance between the temperature increase caused by RFR and the temperature decrease caused by anesthesia.

A Protocol for Sedation Free MRI and PET Imaging in Adults with Autism Spectrum Disorder

Imaging technologies such as positron emission tomography (PET) and magnetic resonance imaging (MRI) present unparalleled opportunities to investigate the neural basis of autism spectrum disorder (ASD). However, challenges such as deficits in social interaction, anxiety around new experiences, impaired language abilities, and hypersensitivity to sensory stimuli make participating in neuroimaging studies challenging for individuals with ASD. In this commentary, we describe the existent training protocols for preparing individuals with ASD for PET/MRI scans and our own experience developing a training protocol to facilitate the inclusion of low-functioning adults with ASD in PET-MRI studies. We hope to raise awareness of the need for more information exchange between research groups about lessons learned in this context in order to include the entire disease spectrum in neuroimaging studies.

Added Value From Abbreviated Brain MRI in Children With Headache

OBJECTIVE. The purposes of this article are to describe implementation of an abbreviated brain MRI protocol for use in children with primary headache and to present an experience with the adaptation of the protocol in practice, work flow integration, and effects on sedation use. CONCLUSION. The abbreviated brain MRI protocol reduced the need for sedation for 74% of the study sample. Use of this protocol in this particular patient population continues, but further validation is required before its use is expanded to other pediatric populations.

Genetic and environmental influences on MRI scan quantity and quality

The current study provides an overview of quantity and quality of MRI data in a large developmental twin sample (N = 512, aged 7–9), and investigated to what extent scan quantity and quality were influenced by genetic and environmental factors. This was examined in a fixed scan protocol consisting of two functional MRI tasks, high resolution structural anatomy (3DT1) and connectivity (DTI) scans, and a resting state scan. Overall, scan quantity was high (88% of participants completed all runs), while scan quality decreased with increasing session length. Scanner related distress was negatively associated with scan quantity (i.e., completed runs), but not with scan quality (i.e., included runs). In line with previous studies, behavioral genetic analyses showed that genetics explained part of the variation in head motion, with heritability estimates of 29% for framewise displacement and 65% for absolute displacement. Additionally, our results revealed that subtle head motion (after exclusion of excessive head motion) showed lower heritability estimates (0–14%), indicating that findings of motion-corrected and quality-controlled MRI data may be less confounded by genetic factors. These findings provide insights in factors contributing to scan quality in children, an issue that is highly relevant for the field of developmental neuroscience.

Using a checklist to assess if a child undergoing MRI needs general anaesthesia

AIM

To assess if a child-assessment checklist covering tasks children are expected to perform during magnetic resonance imaging (MRI) can determine whether the child requires general anaesthesia (GA) during MRI.

MATERIALS AND METHODS

In this institute review board approved study, children who underwent MRI from September 2016 to June 2017 at KK Women's and Children's Hospital were assessed using a checklist by a research assistant before their examination. During this project, the checklist had no influence on whether the MRI was performed under GA or not. The checklist consisted of five items rated on a binary scale assessing the child's behaviour. Binary logistic regression was performed separately on the overall sample and for a subset of younger children to identify variables associated with the requirement for GA.

RESULTS

The mean age of the overall sample (798 children) and the subset of children <8 years (124 children) were 11.7±3.7 and 5.5±1.3 years, respectively. In both groups, children who required GA were significantly younger than those who did not (p<0.001). No gender differences were observed. Children who required GA scored higher on the checklist compared to those who did not in both groups (p<0.001). The diagnostic accuracy of the checklist was found to be good (area under the curve [AUC]=0.97 for both groups), with a suggested cut-off score of 4. Intraclass correlation coefficient of the ratings by two independent individuals was 0.78.

CONCLUSION

The child assessment checklist was useful in identifying GA requirement in children undergoing MRI and can be administered by non-medical staff with good inter-rater reliability.

A review of diffusion MRI of typical white matter development from early childhood to young adulthood

Understanding typical, healthy brain development provides a baseline from which to detect and characterize brain anomalies associated with various neurological or psychiatric disorders and diseases. Diffusion MRI is well suited to study white matter development, as it can virtually extract individual tracts and yield parameters that may reflect alterations in the underlying neural micro-structure (e.g. myelination, axon density, fiber coherence), though it is limited by its lack of specificity and other methodological concerns. This review summarizes the last decade of diffusion imaging studies of healthy white matter development spanning childhood to early adulthood (4-35 years). Conclusions about anatomical location, rates, and timing of white matter development with age are discussed, as well as the influence of image acquisition, analysis, age range/sample size, and statistical model. Despite methodological variability between studies, some consistent findings have emerged from the literature. Specifically, diffusion studies of neurodevelopment overwhelmingly demonstrate regionally varying increases of fractional anisotropy and decreases of mean diffusivity during childhood and adolescence, some of which continue into adulthood. While most studies use linear fits to model age-related changes, studies with sufficient sample sizes and age range provide clear evidence that white matter development (as indicated by diffusion) is non-linear. Several studies further suggest that maturation in association tracts with frontal-temporal connections continues later than commissural and projection tracts. The emerging contributions of more advanced diffusion methods are also discussed, as they may reveal new aspects of white matter development. Although non-specific, diffusion changes may reflect increases of myelination, axonal packing, and/or coherence with age that may be associated with changes in cognition.

Does pre-scanning training improve the image quality of children receiving magnetic resonance imaging?: A meta-analysis of current studies

BACKGROUND

Magnetic resonance imaging (MRI) is often used in children for its clear display of body parts. But it is usually hard to acquire high-quality images, for the uncooperative ability of children. It is believed that pre-MRI training could ensure the high quality of images. The current meta-analysis was done to analyze the current evidences in this field.

METHODS

PubMed, Cochrane Library, and Web of Science were systematically searched up to July 2018, for studies assessing the effects of training on pediatric MRI. Data, including image quality, failed scanning rate, and sedation use, were extracted and analyzed using Revman 5.2 software.

RESULTS

There were 5 studies with 379 subjects in the meta-analysis. Training and control groups were quite comparable when accepted image quality was reviewed (P = .30), but a lower rate of excellent image quality was found in subjects with training (P = .02). The pooling results found no significance between training and control group in sedation use (P = .09) and successful MRI scanning (P = .63).

CONCLUSIONS

It is cautious to conclude that pre-MRI training does not improve the image quality and reduce sedation use among children, for the limited number of studies and sample size. More trials should be encouraged to demonstrate this issue.

The development of brain white matter microstructure

Throughout infancy, childhood, and adolescence, our brains undergo remarkable changes. Processes including myelination and synaptogenesis occur rapidly across the first 2-3 years of life, and ongoing brain remodeling continues into young adulthood. Studies have sought to characterize the patterns of structural brain development, and early studies predominately relied upon gross anatomical measures of brain structure, morphology, and organization. MRI offers the ability to characterize and quantify a range of microstructural aspects of brain tissue that may be more closely related to fundamental neurodevelopmental processes. Techniques such as diffusion, magnetization transfer, relaxometry, and myelin water imaging provide insight into changing cyto- and myeloarchitecture, neuronal density, and structural connectivity. In this review, we focus on the growing body of literature exploiting these MRI techniques to better understand the microstructural changes that occur in brain white matter during maturation. Our review focuses on studies of normative brain development from birth to early adulthood (∼25 years), and places particular emphasis on longitudinal studies and newer techniques that are being used to study microstructural white matter development. All imaging methods demonstrate consistent, rapid microstructural white matter development over the first 3 years of life, suggesting increased myelination and axonal packing. Diffusion studies clearly demonstrate continued white matter maturation during later childhood and adolescence, though the lack of consistent findings in other modalities suggests changes may be mainly due to axonal packing. An emerging literature details differential microstructural development in boys and girls, and connects developmental trajectories to cognitive abilities, behaviour, and/or environmental factors, though the nature of these relationships remains unclear. Future research will need to focus on newer imaging techniques and longitudinal studies to provide more detailed information about microstructural white matter development, particularly in the childhood years.

Clinical application of advanced MR methods in children: points to consider

The application of both functional MRI and diffusion MR tractography prior to a neurosurgical operation is well established in adults, but less so in children, for several reasons. For this review, we have identified several aspects (task design, subject preparation, actual scanning session, data processing, interpretation of results, and decision-making) where pediatric peculiarities should be taken into account. Further, we not only systematically identify common issues, but also provide solutions, based on our experience as well as a review of the pertinent literature. The aim is to provide the clinician as well as the imaging scientist with information that helps to plan, conduct, and interpret such a clinically-indicated exam in a way that maximizes benefit for, and minimizes the burden on the individual child.

Children centered care: Minimizing the need for anesthesia with a multi-faceted concept for MRI in children aged 4-6

PURPOSE

To evaluate the need for general anesthesia (GA) in MRI in children aged 4-6 years, using a multi-faceted concept, Children Centered Care (CCC), compared to a standard setup.

MATERIALS AND METHODS

In this prospective study of 81 children, we developed and tested a multi-faceted concept, CCC, for MRI in children aged 4-6 without GA, comparing it to a standard setup. The CCC included: 1) an interactive app, 2) a trained pediatric team, 3) a children's lounge with a toy-scanner, and 4) a child-friendly multimedia environment in the MRI room. Patients were included from February-September 2016 and 2017. The use of GA was evaluated, image quality was assessed and a cost-benefit analysis was done.

RESULTS

We included 40 children in the control group and 41 in the CCC group. Mean age was 5.8 years and 48 (59%) were males. Neuro and orthopedic imaging accounted for 58 (72%) and 22 (27%), respectively. With the CCC setup 39/41 (95%) completed a diagnostic MRI without GA compared to 17/40 (43%) in the control group (p < 0.001). Image quality was not different between the groups (p = 0.37). The setup proved cost-effective with a payback time of two years in a Danish setting with 250 eligible patients per year.

CONCLUSION

With the multi-faceted concept CCC, the use of GA for MRI in children aged 4-6 was markedly reduced to 5%, image quality was maintained and the setup was cost-effective.

Video-based Education to Reduce Distress and Improve Understanding among Pediatric MRI Patients: A Randomized Controlled Study

PURPOSE

Evaluate the effectiveness of an educational video vs. standard of care in improving relaxation and procedural understanding among pediatric patients undergoing a magnetic resonance imaging (MRI) procedure.

DESIGN AND METHODS

This pilot randomized controlled trial was conducted in a large, urban academic children's hospital. Pediatric patients were randomized to receive either a 7-minute educational video or standard of care. Standardized surveys, which consisted of a 1-10 visual analog scale and open-ended questions were administered to patients to measure their level of relaxation, understanding of the procedure, and perceptions of the MRI education received. Bivariate statistics were used to compare changes in relaxation score and baseline understanding scores between study groups. Open-ended questions were analyzed using content analysis.

RESULTS

A total of 50 pediatric patients completed the study. Improvements in relaxation scores and baseline procedural understanding scores were significantly higher among children 13-17 years of age who received the intervention compared to those that did not (P < 0.05). No statistically significant differences were noted in relaxation scores and procedural understanding scores among children < 13 years of age between study groups. A total of 26 patients, half from the control group and half from the intervention group responded to open-ended survey questions. Content analysis revealed that nearly all respondents perceived the educational video to increase their understanding of the MRI procedure.

CONCLUSIONS

Video-based education effectively improved the relaxation and procedural understanding of children 13-17 years of age undergoing a MRI.

PRACTICE IMPLICATIONS

Nurses may use video-based education to supplement existing MRI education among older children.

Factors Associated With Successful MRI Scanning in Unsedated Young Children

Introduction: Young children are often unable to remain still for magnetic resonance imaging (MRI), leading to unusable images. Various preparation methods may increase success, though it is unclear which factors best predict success. Here, in a retrospective sample, we describe factors associated with successful scanning in unsedated young children. We hypothesized that the mock scanner training and fewer behavior problems would result in higher success rates. Methods: We recruited 134 children aged 2.0-5.0 years for an MRI study. We compared success between children whose parents opted for mock scanner training (n = 20) or not (n = 114), and evaluated demographic and cognitive factors that predicted success. Results: Ninety-seven children (72%) completed at least one MRI sequence successfully on their first try; 64 children (48%) provided high-quality data for all 3 structural imaging sequences. Cognitive scores were higher in successful than unsuccessful children. Children who received mock scanner training were no more likely to be successful than children without, though they had slightly higher scores on T1 image quality. Conclusions: Our data shows that scanning with minimial preparation is possible in young children, and suggests limited advantages of mock scanner preparation for healthy young children.Cognitive ability may predict success.

Evaluation of an internet-based animated preparatory video for children undergoing non-sedated MRI

OBJECTIVES

We evaluate the value of an internet-based educational animated video designed to prepare children for MRI scans, and whether this video reduces scan-related anxiety in children with a neurological disorder, and healthy controls.

METHODS

Participants completed a pre- and post-scan questionnaire evaluating participant online viewing behaviour, understanding of the MRI procedure, anxiety regarding the MRI, impact of animation in preparing the child and whether the child's expectation of the MRI scan matched their experience.

RESULTS

21 children were recruited (12 healthy controls) ranging in age from 6.5 to 11.5 years. The animation was successfully accessed by participants on a range of digital devices and had high levels of approval. Children who viewed the animation had a good understanding of the MRI procedure and low anxiety levels prior to the scan, and reported that their expectations broadly matched the real-life MRI experience. Children reported that the animation positively impacted on their preparation with similar ratings before and after the scan, and the impact on preparation was rated greater by younger children. There were no group differences between healthy children and those with the neurological disorder for ratings of anxiety, impact on preparation and expectation of the experience.

CONCLUSION

This evaluation demonstrates accessibility, acceptability and relevance of internet-based educational animation for typically developing children, and children with a neurodisability aged 6 to 11 years, with positive impact on preparation for MRI. Advances in knowledge: The internet-based educational animation provides a widely accessible tool to support preparation of children for non-sedated MRI.

Pediatric anesthesia and neurotoxicity: what the radiologist needs to know

The use of cross-sectional imaging in the pediatric population continues to rise, particularly the use of MRI. Limiting motion artifact requires cooperative subjects who do not move during imaging, so there has been an increase in the need for pediatric sedation or anesthesia. Over the last decade, concern has increased that exposure to anesthesia might be associated with long-term cognitive deficits. In this review we report current understanding of the effects of anesthesia on the pediatric population, with special focus on long-term developmental and cognitive outcomes, and suggest how radiologists can use new technologies or imaging strategies to mitigate or minimize these potential risks.

Diffusion MRI of white matter microstructure development in childhood and adolescence: Methods, challenges and progress

Diffusion magnetic resonance imaging (dMRI) continues to grow in popularity as a useful neuroimaging method to study brain development, and longitudinal studies that track the same individuals over time are emerging. Over the last decade, seminal work using dMRI has provided new insights into the development of brain white matter (WM) microstructure, connections and networks throughout childhood and adolescence. This review provides an introduction to dMRI, both diffusion tensor imaging (DTI) and other dMRI models, as well as common acquisition and analysis approaches. We highlight the difficulties associated with ascribing these imaging measurements and their changes over time to specific underlying cellular and molecular events. We also discuss selected methodological challenges that are of particular relevance for studies of development, including critical choices related to image acquisition, image analysis, quality control assessment, and the within-subject and longitudinal reliability of dMRI measurements. Next, we review the exciting progress in the characterization and understanding of brain development that has resulted from dMRI studies in childhood and adolescence, including brief overviews and discussions of studies focusing on sex and individual differences. Finally, we outline future directions that will be beneficial to the field.

Nuclear Medicine Procedures in Children: Special Considerations

Nuclear medicine imaging in children is best accomplished when a child-friendly environment is provided for patients and parents. An approach that minimizes patient anxiety and fear is described. International guidelines for administered activity should be used to minimize absorbed radiation doses from radiopharmaceuticals. CT exposure parameters may be reduced to pediatric best practice for diagnostic CT and further reduced when CT images are needed only for localization purposes.

Animated educational video to prepare children for MRI without sedation: evaluation of the appeal and value

BACKGROUND

MRI scans can be distressing for children and often require sedation. Educating children about what to expect reduces anxiety and increases likelihood of successful non-sedated MRI scans. Multimedia tools are a popular means of education. Animated video could provide a free, accessible method of preparing children for MRI scans.

OBJECTIVE

To evaluate a new animation video for preparing children for MRI, specifically for decreasing in-scanner motion and examination failure.

MATERIALS AND METHODS

We recruited 24 healthy children ages 5-11 years. Participants underwent pre- and post-viewing questionnaires and structured interviews. We then compared median Likert scale score changes between pre- and post-animation questions and analyzed the interview framework. Participants were filmed viewing the animation to calculate time spent looking at the screen to assess how well the video retained children's attention.

RESULTS

There were significant improvements in median scores regarding what to expect, checking for metal and keeping still. There were no significant changes in other knowledge-based topics. There were significant improvements in median scores for anxiety-based topics. On average, children watched the screen for 98.9% of the 174-s animation.

CONCLUSION

The animation improved knowledge, reduced anxiety, retained attention and was enjoyed by participants. It can be accessed freely via the Internet to help prepare children ages 5-11 for having an MRI scan.

Does preparation of children before MRI reduce the need for anesthesia? Prospective randomized control trial

BACKGROUND

Magnetic resonance imaging has been recognized for years as the safest and most precise imaging method, particularly for children. The accuracy of MRI depends on avoidance of patient movement during the study. This may be difficult for children and may require anesthesia.

OBJECTIVE

We evaluated an introductory instruction program as an assistive tool in performing MRI without anesthesia.

MATERIALS AND METHODS

In one institution, 121 children were randomized to undergo full interactive pre-MRI instruction (n=64), which included an instructional booklet, movie and simulator practice, or partial instruction (n=57), comprised of the booklet only. All researchers and health care professionals involved, except for the one who instructed the families, were masked to the group allocation. Parents' anxiety, according to the Spielberger state anxiety inventory, was measured.

RESULTS

Median age was 7.4 years (range: 5 years-16 years). Anesthesia was required for fewer children who received full compared to partial instruction: 17 (27%) vs. 27 (47%), P≤0.02. The median anxiety level prior to instruction was higher than the median level after instruction, for both the partial and full instruction groups.

CONCLUSION

Instruction including simulator practice was associated with a decreased need for anesthesia among children undergoing MRI scans.

Does preparation of children before MRI reduce the need for anesthesia? Prospective randomized control trial

BACKGROUND

Magnetic resonance imaging has been recognized for years as the safest and most precise imaging method, particularly for children. The accuracy of MRI depends on avoidance of patient movement during the study. This may be difficult for children and may require anesthesia.

OBJECTIVE

We evaluated an introductory instruction program as an assistive tool in performing MRI without anesthesia.

MATERIALS AND METHODS

In one institution, 121 children were randomized to undergo full interactive pre-MRI instruction (n=64), which included an instructional booklet, movie and simulator practice, or partial instruction (n=57), comprised of the booklet only. All researchers and health care professionals involved, except for the one who instructed the families, were masked to the group allocation. Parents' anxiety, according to the Spielberger state anxiety inventory, was measured.

RESULTS

Median age was 7.4 years (range: 5 years-16 years). Anesthesia was required for fewer children who received full compared to partial instruction: 17 (27%) vs. 27 (47%), P≤0.02. The median anxiety level prior to instruction was higher than the median level after instruction, for both the partial and full instruction groups.

CONCLUSION

Instruction including simulator practice was associated with a decreased need for anesthesia among children undergoing MRI scans.

Cardiovascular magnetic resonance is successfully feasible in many patients aged 3 to 8years without general anesthesia or sedation

OBJECTIVES

Patients younger than 8 years are usually examined by cardiovascular magnetic resonance (CMR) under general anesthesia (GA) or sedation without intubation. Therefore, we sought to study the feasibility of CMR in patients aged 3 to 8years without GA or sedation.

PATIENTS

Data sets of 71 consecutive patients aged 3 to 8years were studied retrospectively.

DESIGN

The total cohort was divided into 2 groups: a no-GA or sedation without intubation group (no-GA or sedation) and a GA or sedation without intubation group (GA or sedation).

MEASUREMENTS

The patients' age, scan durations for each group, successfully answered clinical question, and number of sequences per study were compared between both groups.

MAIN RESULTS

Scan duration in the no-GA or sedation group (n=44) was 35± 20minutes, and that in the GA or sedation group (n=27) was 60± 31minutes (P<.001). The percentage of successful reports was 95% (42/44) in the no-GA or sedation group and 89% (24 of 27) in the GA or sedation group (P=.29).

CONCLUSION

CMR in patients aged 3 to 8years is usually successfully feasible without GA or sedation.