1
|
Falsaperla R, Marino S, Ganci N, Leone G, Romano C, Tropea A, Romeo P, Mailo J, Ruggieri M. Magnetic Resonance Imaging in Preterm Infant: A Systematic Review on Clinical Procedure Safety. Top Magn Reson Imaging 2024; 33:e0310. [PMID: 38329378 DOI: 10.1097/rmr.0000000000000310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/03/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Currently, there is no evidence that MRI produces harmful effects on premature newborns, as well as short-term and long-term safety issues regarding radiofrequency fields and loud acoustic environment, while the examination that is being performed has not been clearly investigated. MRI of the brain conducted on preterm infants should be part of the diagnostic workup, when necessary. This article is intended to evaluate the short-term safety of MRI performed in preterm infants, when required, by analyzing all vital parameters available before, during, and after the MRI procedures. METHODS We conducted a systematic review of the literature on electronic medical databases (PubMed and ClinicalTrials.gov) following the Preferred Reported Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We included all preterm infants who underwent MRI whose clinical, hemodynamic, and respiratory parameters were reported. The quality of the included articles was assessed using QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) tool. RESULTS Six studies were included with a total of 311 preterm infants. No severe adverse event, such as death, occurred during MRI procedures. Vital signs remained stable in about two-thirds of all patients. CONCLUSIONS Given the general clinical safety of MRI, we suggest it as a tool to be used in preterm infants in Neonatal Intensive Care Units, when necessary. We further suggest the development of standard protocols to guide the use of MRI in preterm infants to maximize the clinical safety of the procedure.
Collapse
Affiliation(s)
- Raffaele Falsaperla
- Pediatric and Pediatric Emergency Department, University Hospital "Rodolico- San Marco," PO "San Marco", Catania, Italy
- Unit of Intensive Care and Neonatology, University Hospital "Rodolico- San Marco," PO "San Marco", Catania, Italy
| | - Silvia Marino
- Pediatric and Pediatric Emergency Department, University Hospital "Rodolico- San Marco," PO "San Marco", Catania, Italy
| | - Noemi Ganci
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University Hospital "Rodolico- San Marco", PO "Rodolico", Catania, Italy
| | - Guido Leone
- Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University Hospital "Rodolico- San Marco", PO "Rodolico", Catania, Italy
| | - Catia Romano
- Pediatric and Pediatric Emergency Department, University Hospital "Rodolico- San Marco," PO "San Marco", Catania, Italy
| | - Angela Tropea
- Unit of Radiology, University Hospital "Rodolico- San Marco," PO "San Marco", Catania, Italy
| | - Placido Romeo
- Unit of Radiology, University Hospital "Rodolico- San Marco," PO "San Marco", Catania, Italy
| | - Janette Mailo
- Division of Pediatric Neurology, University of Alberta, Edmonton, Alberta, Canada;and
| | - Martino Ruggieri
- Unit of Rare Diseases of the Nervous System in Childhood, Department of Clinical and Experimental Medicine, Section of Pediatrics and Child Neuropsychiatry, University of Catania, Catania, Italy
| |
Collapse
|
2
|
Bridgen P, Tomi-Tricot R, Uus A, Cromb D, Quirke M, Almalbis J, Bonse B, De la Fuente Botella M, Maggioni A, Cio PD, Cawley P, Casella C, Dokumaci AS, Thomson AR, Willers Moore J, Bridglal D, Saravia J, Finck T, Price AN, Pickles E, Cordero-Grande L, Egloff A, O’Muircheartaigh J, Counsell SJ, Giles SL, Deprez M, De Vita E, Rutherford MA, Edwards AD, Hajnal JV, Malik SJ, Arichi T. High resolution and contrast 7 tesla MR brain imaging of the neonate. FRONTIERS IN RADIOLOGY 2024; 3:1327075. [PMID: 38304343 PMCID: PMC10830693 DOI: 10.3389/fradi.2023.1327075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/29/2023] [Indexed: 02/03/2024]
Abstract
Introduction Ultra-high field MR imaging offers marked gains in signal-to-noise ratio, spatial resolution, and contrast which translate to improved pathological and anatomical sensitivity. These benefits are particularly relevant for the neonatal brain which is rapidly developing and sensitive to injury. However, experience of imaging neonates at 7T has been limited due to regulatory, safety, and practical considerations. We aimed to establish a program for safely acquiring high resolution and contrast brain images from neonates on a 7T system. Methods Images were acquired from 35 neonates on 44 occasions (median age 39 + 6 postmenstrual weeks, range 33 + 4 to 52 + 6; median body weight 2.93 kg, range 1.57 to 5.3 kg) over a median time of 49 mins 30 s. Peripheral body temperature and physiological measures were recorded throughout scanning. Acquired sequences included T2 weighted (TSE), Actual Flip angle Imaging (AFI), functional MRI (BOLD EPI), susceptibility weighted imaging (SWI), and MR spectroscopy (STEAM). Results There was no significant difference between temperature before and after scanning (p = 0.76) and image quality assessment compared favorably to state-of-the-art 3T acquisitions. Anatomical imaging demonstrated excellent sensitivity to structures which are typically hard to visualize at lower field strengths including the hippocampus, cerebellum, and vasculature. Images were also acquired with contrast mechanisms which are enhanced at ultra-high field including susceptibility weighted imaging, functional MRI, and MR spectroscopy. Discussion We demonstrate safety and feasibility of imaging vulnerable neonates at ultra-high field and highlight the untapped potential for providing important new insights into brain development and pathological processes during this critical phase of early life.
Collapse
Affiliation(s)
- Philippa Bridgen
- LondonCollaborative Ultra High Field System (LoCUS), King’s College London, London, United Kingdom
- Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Raphael Tomi-Tricot
- LondonCollaborative Ultra High Field System (LoCUS), King’s College London, London, United Kingdom
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- MR Research Collaborations, Siemens Healthcare Limited, London, United Kingdom
| | - Alena Uus
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Daniel Cromb
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Megan Quirke
- Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Jennifer Almalbis
- Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Beya Bonse
- Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Miguel De la Fuente Botella
- Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Alessandra Maggioni
- Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Pierluigi Di Cio
- LondonCollaborative Ultra High Field System (LoCUS), King’s College London, London, United Kingdom
- Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Paul Cawley
- Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Chiara Casella
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Ayse Sila Dokumaci
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Alice R. Thomson
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London, United Kingdom
| | - Jucha Willers Moore
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London, United Kingdom
| | - Devi Bridglal
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Joao Saravia
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Thomas Finck
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Anthony N. Price
- Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Elisabeth Pickles
- LondonCollaborative Ultra High Field System (LoCUS), King’s College London, London, United Kingdom
- Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Lucilio Cordero-Grande
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Biomedical Image Technologies, ETSI Telecomunicación, Universidad Politécnica de Madrid and CIBER-BBN, ISCIII, Madrid, Spain
| | - Alexia Egloff
- Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Jonathan O’Muircheartaigh
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London, United Kingdom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Serena J. Counsell
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Sharon L. Giles
- LondonCollaborative Ultra High Field System (LoCUS), King’s College London, London, United Kingdom
- Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Maria Deprez
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Enrico De Vita
- LondonCollaborative Ultra High Field System (LoCUS), King’s College London, London, United Kingdom
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- MR Physics, Radiology Department, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Mary A. Rutherford
- Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London, United Kingdom
| | - A. David Edwards
- Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London, United Kingdom
| | - Joseph V. Hajnal
- LondonCollaborative Ultra High Field System (LoCUS), King’s College London, London, United Kingdom
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Shaihan J. Malik
- LondonCollaborative Ultra High Field System (LoCUS), King’s College London, London, United Kingdom
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Tomoki Arichi
- Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
- Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
- MRC Centre for Neurodevelopmental Disorders, King’s College London, London, United Kingdom
| |
Collapse
|
3
|
van Ooijen I, Annink K, Benders M, Dudink J, Alderliesten T, Groenendaal F, Tataranno M, Lequin M, Hoogduin J, Visser F, Raaijmakers A, Klomp D, Wiegers E, Wijnen J, van der Aa N. Introduction of ultra-high-field MR brain imaging in infants: vital parameters, temperature and comfort. NEUROIMAGE. REPORTS 2023; 3:100175. [PMID: 38357432 PMCID: PMC10865273 DOI: 10.1016/j.ynirp.2023.100175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/19/2023] [Accepted: 05/20/2023] [Indexed: 02/16/2024]
Abstract
Background Brain MRI in infants at ultra-high-field scanners might improve diagnostic quality, but safety should be evaluated first. In our previous study, we reported simulated specific absorption rates and acoustic noise data at 7 Tesla. Methods In this study, we included twenty infants between term-equivalent age and three months of age. The infants were scanned on a 7 Tesla MRI directly after their clinically indicated 3 Tesla brain MRI scan. Vital parameters, temperature, and comfort were monitored throughout the process. Brain temperature was estimated during the MRI scans using proton MR spectroscopy. Results We found no significant differences in vital parameters, temperature, and comfort during and after 7 Tesla MRI scans, compared to 3 Tesla MRI scans. Conclusions These data confirm our hypothesis that scanning infants at 7 Tesla MRI appears to be safe and we identified no additional risks from scanning at 3 Tesla MRI.
Collapse
Affiliation(s)
- I.M. van Ooijen
- Department of Neonatology, University Medical Center Utrecht, Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands
- Centre for Image Sciences, High Field MR Research, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - K.V. Annink
- Department of Neonatology, University Medical Center Utrecht, Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands
| | - M.J.N.L. Benders
- Department of Neonatology, University Medical Center Utrecht, Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands
| | - J. Dudink
- Department of Neonatology, University Medical Center Utrecht, Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands
| | - T. Alderliesten
- Department of Neonatology, University Medical Center Utrecht, Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands
| | - F. Groenendaal
- Department of Neonatology, University Medical Center Utrecht, Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands
| | - M.L. Tataranno
- Department of Neonatology, University Medical Center Utrecht, Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands
| | - M.H. Lequin
- Departement of Radiology, Division of Imaging and Oncology, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - J.M. Hoogduin
- Centre for Image Sciences, High Field MR Research, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - F. Visser
- Centre for Image Sciences, High Field MR Research, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - A.J.E. Raaijmakers
- Centre for Image Sciences, High Field MR Research, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - D.W.J. Klomp
- Centre for Image Sciences, High Field MR Research, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - E.C. Wiegers
- Centre for Image Sciences, High Field MR Research, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - J.P. Wijnen
- Centre for Image Sciences, High Field MR Research, University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - N.E. van der Aa
- Department of Neonatology, University Medical Center Utrecht, Utrecht Brain Center, University Utrecht, Utrecht, the Netherlands
| |
Collapse
|
4
|
Bin-Nun A, Kasirer Y, Abu-Ata N, Rosenbaum D, Cytter-Kuint R, Hammerman C, Ben-David E. Detection of Global Brain Injury Using Point-of-Care Neonatal MRI Scanner. Neuropediatrics 2023. [PMID: 35977705 DOI: 10.1055/a-1926-2238] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Conventional magnetic resonance imaging (MRI) neuroimaging of infants is complicated by the need to transport infants outside the neonatal intensive care unit (NICU), often to distant areas of the hospital. PRIMARY OBJECTIVE The main aim of this study was to evaluate and compare scoring of images from a novel 1T MRI, which enables neuroimaging within the NICU, with those from a conventional MRI. SECONDARY OBJECTIVE The second aim of this study was to document improved expediency, and thereby greater patient safety, as reflected by decreased transport time. MATERIALS AND METHODS Thirty premature infants (mean gestational age: 28.8 ± 2.1 weeks) were scanned consecutively on the novel 1T and 1.5T conventional scanners at term-equivalent age. Orthogonal T1- and T2-weighted images were acquired and reviewed. A global brain abnormality score (Kidokoro) was assigned independently to all images by two radiologists. Interrater agreement was evaluated using the kappa statistic and interscanner agreement was evaluated by Bland-Altman analysis. Transport time to and from both scanners was monitored and compared. RESULTS Weighted kappas were 0.77 (standard error of measurement [SEM] 0.08; confidence interval [CI]: 0.62-0.92) and 0.86 (SEM: 0.07; CI: 0.73-1), for the 1T and 1.5T scanners, respectively, reflecting substantial interrater agreement. Bland-Altman analysis showed excellent agreement between the two scanners.Transport time was 8 ± 6 minutes for the 1T MRI versus 46 ± 21 minutes for the conventional MRI (p < 0.00001). No adverse events were recorded during transport. Standard transport times will vary from institution to institution. CONCLUSIONS Kidokoro scores are similar when comparing images obtained from a 1T MRI with those of a conventional 1.5T MRI, reflecting comparable image quality. Transport time was significantly decreased using the 1T neonatal MRI.
Collapse
Affiliation(s)
- Alona Bin-Nun
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel.,The Faculty of Medicine, the Hebrew University, Campus Ein Kerem, Jerusalem, Israel
| | - Yair Kasirer
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Nadeen Abu-Ata
- Department of Radiology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Debra Rosenbaum
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ruth Cytter-Kuint
- The Faculty of Medicine, the Hebrew University, Campus Ein Kerem, Jerusalem, Israel
| | - Cathy Hammerman
- Department of Neonatology, Shaare Zedek Medical Center, Jerusalem, Israel.,The Faculty of Medicine, the Hebrew University, Campus Ein Kerem, Jerusalem, Israel
| | - Eliel Ben-David
- The Faculty of Medicine, the Hebrew University, Campus Ein Kerem, Jerusalem, Israel.,Department of Radiology, Shaare Zedek Medical Center, Jerusalem, Israel
| |
Collapse
|
5
|
Malik SJ, Hand JW, Satnarine R, Price AN, Hajnal JV. Specific absorption rate and temperature in neonate models resulting from exposure to a 7T head coil. Magn Reson Med 2021; 86:1299-1313. [PMID: 33811667 DOI: 10.1002/mrm.28784] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 02/11/2021] [Accepted: 03/06/2021] [Indexed: 11/07/2022]
Abstract
PURPOSE To investigate safe limits for neonatal imaging using a 7T head coil, including both specific absorption rate (SAR) and temperature predictions. METHODS Head-centered neonate models were simulated using finite-difference time domain-based electromagnetic and thermal solvers. The effects of higher water content of neonatal tissues compared with adults, position shifts, and thermal insulation were also considered. An adult model was simulated for comparison. RESULTS Maximum and average SAR are both elevated in the neonate when compared with an adult model. When normalized to B1+ , the SAR experienced by a neonate is greater than an adult by approximately a factor of 2; when normalized to net forward power (forward-reflected), this increases to a factor of 2.5-3.0; and when normalized to absorbed power, approximately a factor of 4. Use of age-adjusted dielectric properties significantly increases the predicted SAR, compared with using adult tissue properties for the neonates. Thermal simulations predict that change in core temperature/maximum temperature remain compliant with International Electrotechnical Commission limits when a thermally insulated neonate is exposed at the SAR limit for up to an hour. CONCLUSION This study of two neonate models cannot quantify the variability expected within a larger population. Likewise, the use of age-adjusted dielectric properties have a significant effect, but while their use is well motivated by literature, there is uncertainty in the true dielectric properties of neonatal tissue. Nevertheless, the main finding is that unlike at lower field strengths, operational limits for 7T neonatal MRI using an adult head coil should be more conservative than limits for use on adults.
Collapse
Affiliation(s)
- Shaihan J Malik
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, United Kingdom.,Center for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, United Kingdom
| | - Jeffrey W Hand
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, United Kingdom
| | - Ryan Satnarine
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, United Kingdom
| | - Anthony N Price
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, United Kingdom.,Center for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, United Kingdom
| | - Joseph V Hajnal
- Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, United Kingdom.,Center for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King's College London, St. Thomas' Hospital, London, United Kingdom
| |
Collapse
|
6
|
Sorg AL, von Kries R, Klemme M, Gerstl L, Felderhoff-Müser U, Dzietko M. Incidence Estimates of Perinatal Arterial Ischemic Stroke in Preterm- and Term-Born Infants: A National Capture-Recapture Calculation Corrected Surveillance Study. Neonatology 2021; 118:727-733. [PMID: 33794541 DOI: 10.1159/000514922] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 02/02/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Data on valid incidence estimates of perinatal arterial ischemic stroke (PAIS) are scarce. This analysis aims to determine incidence of PAIS in term- and preterm-born infants and to investigate clinical differences related to prematurity. METHODS This surveillance study (2015-2017) in all German paediatric hospital estimated incidences for MRI-confirmed PAIS in term and preterm infants. To correct for under-reporting, we performed capture-recapture-calculations (CRC) in the most populous federal state and extrapolated nationwide. Differences in clinical presentation in term- and preterm-born infants were assessed. RESULTS 126 term- and 19 preterm-born infants with PAIS were reported. CRC corrected incidence of PAIS was 22 (95% confidence interval [CI] 17, 27) per 100,000 live births. Stratified by prematurity, the incidence was 32 (95% CI 15, 49) per 100,000 in preterm-born infants and 21 (95% CI 16, 26) per 100,000 term-born infants (significant difference p = 0.001). In symptomatic cases only (n = 120 term born, n = 12 preterm born), incidences did not differ. Risk factor patterns were similar, but number of risk factors in preterm babies was elevated (mean 3.8 vs. 2.9; p = 0.01) and median age at diagnosis was increased (5 vs. 3 days; p = 0.04). Clinical seizures were observed in 88% (106/120) of symptomatic term infants compared to 33% (4/12) in preterm-born infants (p < 0.0001). CONCLUSION PAIS incidence rates in Germany, extrapolated from estimates for completeness of reporting in the largest federal state, were within the range of other population-based studies. As a novel finding, we detected symptomatic PAIS in preterm-born infants to be as common as in term-born infants although their symptoms were often unspecific.
Collapse
Affiliation(s)
- Anna-Lisa Sorg
- Institute of Social Paediatrics and Adolescent Medicine, Division of Paediatric Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Rüdiger von Kries
- Institute of Social Paediatrics and Adolescent Medicine, Division of Paediatric Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Mathias Klemme
- Department of Neonatology, University Children's Hospital and Perinatal Centre, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Lucia Gerstl
- Department of Paediatric Neurology, University Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | | | - Mark Dzietko
- Department of Paediatrics I, Neonatology, University Duisburg-Essen, Essen, Germany
| |
Collapse
|
7
|
Annink KV, van der Aa NE, Dudink J, Alderliesten T, Groenendaal F, Lequin M, Jansen FE, Rhebergen KS, Luijten P, Hendrikse J, Hoogduin HJM, Huijing ER, Versteeg E, Visser F, Raaijmakers AJE, Wiegers EC, Klomp DWJ, Wijnen JP, Benders MJNL. Introduction of Ultra-High-Field MR Imaging in Infants: Preparations and Feasibility. AJNR Am J Neuroradiol 2020; 41:1532-1537. [PMID: 32732273 DOI: 10.3174/ajnr.a6702] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 05/19/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral MR imaging in infants is usually performed with a field strength of up to 3T. In adults, a growing number of studies have shown added diagnostic value of 7T MR imaging. 7T MR imaging might be of additional value in infants with unexplained seizures, for example. The aim of this study was to investigate the feasibility of 7T MR imaging in infants. We provide information about the safety preparations and show the first MR images of infants at 7T. MATERIALS AND METHODS Specific absorption rate levels during 7T were simulated in Sim4life using infant and adult models. A newly developed acoustic hood was used to guarantee hearing protection. Acoustic noise damping of this hood was measured and compared with the 3T Nordell hood and no hood. In this prospective pilot study, clinically stable infants, between term-equivalent age and the corrected age of 3 months, underwent 7T MR imaging immediately after their standard 3T MR imaging. The 7T scan protocols were developed and optimized while scanning this cohort. RESULTS Global and peak specific absorption rate levels in the infant model in the centered position and 50-mm feet direction did not exceed the levels in the adult model. Hearing protection was guaranteed with the new hood. Twelve infants were scanned. No MR imaging-related adverse events occurred. It was feasible to obtain good-quality imaging at 7T for MRA, MRV, SWI, single-shot T2WI, and MR spectroscopy. T1WI had lower quality at 7T. CONCLUSIONS 7T MR imaging is feasible in infants, and good-quality scans could be obtained.
Collapse
Affiliation(s)
- K V Annink
- From the Departments of Neonatology (K.V.A., N.E.v.d.A., J.D., T.A., F.G., M.J.N.L.B.), and Paediatric Neurology (F.E.J.), University Medical Center Utrecht Brain Center
| | - N E van der Aa
- From the Departments of Neonatology (K.V.A., N.E.v.d.A., J.D., T.A., F.G., M.J.N.L.B.), and Paediatric Neurology (F.E.J.), University Medical Center Utrecht Brain Center
| | - J Dudink
- From the Departments of Neonatology (K.V.A., N.E.v.d.A., J.D., T.A., F.G., M.J.N.L.B.), and Paediatric Neurology (F.E.J.), University Medical Center Utrecht Brain Center
| | - T Alderliesten
- From the Departments of Neonatology (K.V.A., N.E.v.d.A., J.D., T.A., F.G., M.J.N.L.B.), and Paediatric Neurology (F.E.J.), University Medical Center Utrecht Brain Center
| | - F Groenendaal
- From the Departments of Neonatology (K.V.A., N.E.v.d.A., J.D., T.A., F.G., M.J.N.L.B.), and Paediatric Neurology (F.E.J.), University Medical Center Utrecht Brain Center
| | - M Lequin
- the Departments of Radiology (M.L., P.L., J.H., H.J.M.H., E.R.H., E.V., F.V., A.J.E.R., E.C.W., D.W.J.K., J.P.W.), and Otorhinolaryngology and Head and Neck Surgery (K.S.R.), University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - F E Jansen
- From the Departments of Neonatology (K.V.A., N.E.v.d.A., J.D., T.A., F.G., M.J.N.L.B.), and Paediatric Neurology (F.E.J.), University Medical Center Utrecht Brain Center
| | - K S Rhebergen
- the Departments of Radiology (M.L., P.L., J.H., H.J.M.H., E.R.H., E.V., F.V., A.J.E.R., E.C.W., D.W.J.K., J.P.W.), and Otorhinolaryngology and Head and Neck Surgery (K.S.R.), University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - P Luijten
- the Departments of Radiology (M.L., P.L., J.H., H.J.M.H., E.R.H., E.V., F.V., A.J.E.R., E.C.W., D.W.J.K., J.P.W.), and Otorhinolaryngology and Head and Neck Surgery (K.S.R.), University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - J Hendrikse
- the Departments of Radiology (M.L., P.L., J.H., H.J.M.H., E.R.H., E.V., F.V., A.J.E.R., E.C.W., D.W.J.K., J.P.W.), and Otorhinolaryngology and Head and Neck Surgery (K.S.R.), University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - H J M Hoogduin
- the Departments of Radiology (M.L., P.L., J.H., H.J.M.H., E.R.H., E.V., F.V., A.J.E.R., E.C.W., D.W.J.K., J.P.W.), and Otorhinolaryngology and Head and Neck Surgery (K.S.R.), University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - E R Huijing
- the Departments of Radiology (M.L., P.L., J.H., H.J.M.H., E.R.H., E.V., F.V., A.J.E.R., E.C.W., D.W.J.K., J.P.W.), and Otorhinolaryngology and Head and Neck Surgery (K.S.R.), University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - E Versteeg
- the Departments of Radiology (M.L., P.L., J.H., H.J.M.H., E.R.H., E.V., F.V., A.J.E.R., E.C.W., D.W.J.K., J.P.W.), and Otorhinolaryngology and Head and Neck Surgery (K.S.R.), University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - F Visser
- the Departments of Radiology (M.L., P.L., J.H., H.J.M.H., E.R.H., E.V., F.V., A.J.E.R., E.C.W., D.W.J.K., J.P.W.), and Otorhinolaryngology and Head and Neck Surgery (K.S.R.), University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - A J E Raaijmakers
- the Departments of Radiology (M.L., P.L., J.H., H.J.M.H., E.R.H., E.V., F.V., A.J.E.R., E.C.W., D.W.J.K., J.P.W.), and Otorhinolaryngology and Head and Neck Surgery (K.S.R.), University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - E C Wiegers
- the Departments of Radiology (M.L., P.L., J.H., H.J.M.H., E.R.H., E.V., F.V., A.J.E.R., E.C.W., D.W.J.K., J.P.W.), and Otorhinolaryngology and Head and Neck Surgery (K.S.R.), University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - D W J Klomp
- the Departments of Radiology (M.L., P.L., J.H., H.J.M.H., E.R.H., E.V., F.V., A.J.E.R., E.C.W., D.W.J.K., J.P.W.), and Otorhinolaryngology and Head and Neck Surgery (K.S.R.), University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - J P Wijnen
- the Departments of Radiology (M.L., P.L., J.H., H.J.M.H., E.R.H., E.V., F.V., A.J.E.R., E.C.W., D.W.J.K., J.P.W.), and Otorhinolaryngology and Head and Neck Surgery (K.S.R.), University Medical Center Utrecht, University Utrecht, Utrecht, the Netherlands
| | - M J N L Benders
- From the Departments of Neonatology (K.V.A., N.E.v.d.A., J.D., T.A., F.G., M.J.N.L.B.), and Paediatric Neurology (F.E.J.), University Medical Center Utrecht Brain Center
| |
Collapse
|
8
|
Annink KV, Groenendaal F, Cohen D, van der Aa NE, Alderliesten T, Dudink J, Benders MJNL, Wijnen JP. Brain temperature of infants with neonatal encephalopathy following perinatal asphyxia calculated using magnetic resonance spectroscopy. Pediatr Res 2020; 88:279-284. [PMID: 31896129 DOI: 10.1038/s41390-019-0739-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/10/2019] [Accepted: 12/15/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Little is known about brain temperature of neonates during MRI. Brain temperature can be estimated non-invasively with proton Magnetic Resonance Spectroscopy (1H-MRS), but the most accurate 1H-MRS method has not yet been determined. The primary aim was to estimate brain temperature using 1H-MRS in infants with neonatal encephalopathy (NE) following perinatal asphyxia. The secondary aim was to compare brain temperature during MRI with rectal temperatures before and after MRI. METHODS In this retrospective study, brain temperature in 36 (near-)term infants with NE was estimated using short (36 ms) and long (288 ms) echo time (TE) 1H-MRS. Brain temperature was calculated using two different formulas: formula of Wu et al. and a formula based on phantom calibration. The methods were compared. Rectal temperatures were collected <3 hours before and after MRI. RESULTS Brain temperatures calculated with the formula of Wu et al. and the calibrated formula were similar as well as brain temperatures derived from short and long TE 1H-MRS. Rectal temperature did not differ before and after MRI. CONCLUSIONS Brain temperature can be measured using 1H-MRS in daily clinical practice using the formula of Wu et al. with both short and long TE 1H-MRS. Brain temperature remained within physiological range during MRI.
Collapse
Affiliation(s)
- Kim V Annink
- Department of Neonatology, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Floris Groenendaal
- Department of Neonatology, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Daan Cohen
- Department of Neonatology, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Niek E van der Aa
- Department of Neonatology, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Thomas Alderliesten
- Department of Neonatology, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Jeroen Dudink
- Department of Neonatology, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Manon J N L Benders
- Department of Neonatology, University Medical Center Utrecht Brain Center, Utrecht University, Utrecht, The Netherlands
| | - Jannie P Wijnen
- Department of Radiology, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands.
| |
Collapse
|
9
|
Nagel E, Hickey M, Teigen L, Kuchnia A, Holm T, Earthman C, Demerath E, Ramel S. Can Ultrasound Measures of Muscle and Adipose Tissue Thickness Predict Body Composition of Premature Infants in the Neonatal Intensive Care Unit? JPEN J Parenter Enteral Nutr 2020; 45:323-330. [DOI: 10.1002/jpen.1829] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 03/03/2020] [Indexed: 01/19/2023]
Affiliation(s)
- Emily Nagel
- Department of Food Science and Nutrition University of Minnesota–Twin Cities Minneapolis Minnesota USA
| | - Marie Hickey
- Department of Pediatrics University of Minnesota–Twin Cities Minneapolis Minnesota USA
| | - Levi Teigen
- Department of Gastroenterology University of Minnesota–Twin Cities Minneapolis Minnesota USA
| | - Adam Kuchnia
- Department of Nutritional Sciences University of Wisconsin–Madison Madison Wisconsin USA
| | - Tara Holm
- Department of Radiology University of Minnesota–Twin Cities Minneapolis Minnesota USA
| | - Carrie Earthman
- Department of Behavioral Health and Nutrition University of Delaware Newark Delaware USA
| | - Ellen Demerath
- School of Public Health University of Minnesota–Twin Cities Minneapolis Minnesota USA
| | - Sara Ramel
- Department of Pediatrics University of Minnesota–Twin Cities Minneapolis Minnesota USA
| |
Collapse
|
10
|
Helmi H, Siddiqui A, Yan Y, Basij M, Hernandez-Andrade E, Gelovani J, Hsu CD, Hassan SS, Mehrmohammadi M. The role of noninvasive diagnostic imaging in monitoring pregnancy and detecting patients at risk for preterm birth: a review of quantitative approaches. J Matern Fetal Neonatal Med 2020; 35:568-591. [PMID: 32089024 DOI: 10.1080/14767058.2020.1722099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Preterm birth (PTB) is the leading cause of neonatal morbidity and mortality worldwide. The ability to predict patients at risk for preterm birth remains a major health challenge. The currently available clinical diagnostics such as cervical length and fetal fibronectin may detect only up to 30% of patients who eventually experience a spontaneous preterm birth. This paper reviews ongoing efforts to improve the ability to conduct a risk assessment for preterm birth. In particular, this work focuses on quantitative methods of imaging using ultrasound-based techniques, magnetic resonance imaging, and optical imaging modalities. While ultrasound imaging is the major modality for preterm birth risk assessment, a summary of efforts to adopt other imaging modalities is also discussed to identify the technical and diagnostic limits associated with adopting them in clinical settings. We conclude the review by proposing a new approach using combined photoacoustic, ultrasound, and elastography as a potential means to better assess cervical tissue remodeling, and thus improve the detection of patients at-risk of PTB.
Collapse
Affiliation(s)
- Hamid Helmi
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - Adeel Siddiqui
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - Yan Yan
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - Maryam Basij
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA
| | - Edgar Hernandez-Andrade
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland and Detroit, MI, USA
| | - Juri Gelovani
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA.,Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Chaur-Dong Hsu
- Perinatology Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S. Department of Health and Human Services, Bethesda, Maryland and Detroit, MI, USA.,Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA
| | - Sonia S Hassan
- Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA.,Office of Women's Health, Wayne State University, Detroit, MI, USA
| | - Mohammad Mehrmohammadi
- Department of Biomedical Engineering, Wayne State University, Detroit, MI, USA.,Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI, USA.,Department of Electrical and Computer Engineering, Wayne State University, Detroit, MI, USA
| |
Collapse
|
11
|
Nguyen AL, Ding Y, Suffren S, Londono I, Luck D, Lodygensky GA. The brain's kryptonite: Overview of punctate white matter lesions in neonates. Int J Dev Neurosci 2019; 77:77-88. [DOI: 10.1016/j.ijdevneu.2019.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 03/28/2019] [Accepted: 04/26/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- Annie L.A. Nguyen
- Sainte‐Justine Hospital Research CenterDepartment of PediatricsUniversity of MontrealMontrealH3T 1C5Canada
- The Canadian Neonatal Brain Platform (CNBP)Canada
| | - Yang Ding
- Sainte‐Justine Hospital Research CenterDepartment of PediatricsUniversity of MontrealMontrealH3T 1C5Canada
- The Canadian Neonatal Brain Platform (CNBP)Canada
| | - Sabrina Suffren
- Sainte‐Justine Hospital Research CenterDepartment of PediatricsUniversity of MontrealMontrealH3T 1C5Canada
- The Canadian Neonatal Brain Platform (CNBP)Canada
| | - Irène Londono
- Sainte‐Justine Hospital Research CenterDepartment of PediatricsUniversity of MontrealMontrealH3T 1C5Canada
- The Canadian Neonatal Brain Platform (CNBP)Canada
| | - David Luck
- Sainte‐Justine Hospital Research CenterDepartment of PediatricsUniversity of MontrealMontrealH3T 1C5Canada
- The Canadian Neonatal Brain Platform (CNBP)Canada
| | - Gregory A. Lodygensky
- Sainte‐Justine Hospital Research CenterDepartment of PediatricsUniversity of MontrealMontrealH3T 1C5Canada
- Department of Pharmacology and PhysiologyUniversity of MontrealMontrealH3T 1J4Canada
- The Canadian Neonatal Brain Platform (CNBP)Canada
| |
Collapse
|
12
|
Fumagalli M, Cinnante CM, Calloni SF, Sorrentino G, Gorla I, Plevani L, Pesenti N, Sirgiovanni I, Mosca F, Triulzi F. Clinical safety of 3-T brain magnetic resonance imaging in newborns. Pediatr Radiol 2018; 48:992-998. [PMID: 29594440 DOI: 10.1007/s00247-018-4105-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 01/21/2018] [Accepted: 02/20/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND The effects and potential hazards of brain magnetic resonance imaging (MRI) at 3 T in newborns are debated. OBJECTIVE Assess the impact of 3-T MRI in newborns on body temperature and physiological parameters. MATERIAL AND METHODS Forty-nine newborns, born preterm and at term, underwent 3-T brain MRI at term-corrected age. Rectal and skin temperature, oxygen saturation and heart rate were recorded before, during and after the scan. RESULTS A statistically significant increase in skin temperature of 0.6 °C was observed at the end of the MRI scan (P<0.01). There was no significant changes in rectal temperature, heart rate or oxygen saturation. CONCLUSION Core temperature, heart rate and oxygen saturation in newborns were not affected by 3-T brain MR scanning.
Collapse
Affiliation(s)
- Monica Fumagalli
- NICU, Department of Clinical Sciences & Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Claudia Maria Cinnante
- Neuroradiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Gabriele Sorrentino
- NICU, Department of Clinical Sciences & Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Ilaria Gorla
- NICU, Department of Clinical Sciences & Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Laura Plevani
- Nursing coordinator S.I.T.R.A. Basic Education Sector-Neonatology and Neonatal Intensive Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Pesenti
- NICU, Department of Clinical Sciences & Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Ida Sirgiovanni
- NICU, Department of Clinical Sciences & Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Fabio Mosca
- NICU, Department of Clinical Sciences & Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Fabio Triulzi
- Neuroradiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| |
Collapse
|
13
|
Conventional MRI. HANDBOOK OF CLINICAL NEUROLOGY 2018. [PMID: 29903441 DOI: 10.1016/b978-0-444-63956-1.00013-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
Conventional magnetic resonance imaging (MRI) allows for a detailed noninvasive visualization/examination of posterior fossa structures and represents a fundamental step in the diagnostic workup of many cerebellar disorders. In the first part of this chapter methodologic issues, like the correct choice of hardware (magnets, coils), pro and cons of the different MRI sequences, and patient management during the examination are discussed. In the second part, the MRI anatomy of the cerebellum, as noted on the various conventional MRI sequences, as well as a detailed description of cerebellar maturational processes from birth to childhood and into adulthood, are reported. Volumetric studies on the cerebellar growth based on three-dimensional MRI sequences are also presented. Moreover, we briefly discuss two main topics regarding conventional MRI of the cerebellum that have generated some debate in recent years: the differentiation between cerebellar atrophy, hypoplasia, and pontocerebellar hypoplasia, and signal changes of dentate nuclei after repetitive gadolinium-based contrast injections. The advantages and benefits of advanced neuroimaging techniques, including 1H magnetic resonance spectroscopy, diffusion-weighted imaging, diffusion tensor imaging, and perfusion-weighted imaging are discussed in the last section of the chapter.
Collapse
|
14
|
George JM, Pannek K, Rose SE, Ware RS, Colditz PB, Boyd RN. Diagnostic accuracy of early magnetic resonance imaging to determine motor outcomes in infants born preterm: a systematic review and meta-analysis. Dev Med Child Neurol 2018; 60:134-146. [PMID: 29193032 DOI: 10.1111/dmcn.13611] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2017] [Indexed: 01/18/2023]
Abstract
AIM To examine the diagnostic ability of early magnetic resonance imaging (MRI; <36wks postmenstrual age) to detect later adverse motor outcomes or cerebral palsy (CP) in infants born preterm. METHOD Studies of infants born preterm with MRI earlier than 36 weeks postmenstrual age and quantitative motor data or a diagnosis of CP at or beyond 1 year corrected age were identified. Study details were extracted and meta-analyses performed where possible. Quality of included studies was evaluated with the QUADAS-2 (a revised tool for the quality assessment of diagnostic accuracy studies). RESULTS Thirty-one articles met the inclusion criteria, five of which reported diagnostic accuracy and five reported data sufficient for calculation of diagnostic accuracy. Early structural MRI global scores detected a later diagnosis of CP with a pooled sensitivity of 100% (95% confidence interval [CI] 86-100) and a specificity of 93% (95% CI 59-100). Global structural MRI scores determined adverse motor outcomes with a pooled sensitivity of 89% (95% CI 44-100) and a specificity of 98% (95% CI 90-100). White matter scores determined adverse motor outcomes with a pooled sensitivity of 33% (95% CI 20-48) and a specificity of 83% (95% CI 78-88). INTERPRETATION Early structural MRI has reasonable sensitivity and specificity to determine adverse motor outcomes and CP in infants born preterm. Greater reporting of diagnostic accuracy in studies examining relationships with motor outcomes and CP is required to facilitate clinical utility of early MRI. WHAT THIS PAPER ADDS Early magnetic resonance imaging (MRI) has reasonable sensitivity and specificity to determine later adverse motor outcomes and cerebral palsy (CP). Detection of infants who progressed to CP was stronger than motor outcomes. Global MRI scores determined adverse motor outcomes more accurately than white matter scores. Few studies report diagnostic accuracy of early MRI findings. Diagnostic accuracy is required to draw clinically meaningful conclusions from early MRI studies.
Collapse
Affiliation(s)
- Joanne M George
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Kerstin Pannek
- The Australian e-Health Research Centre, Health and Biosecurity, CSIRO, Brisbane, Australia
| | - Stephen E Rose
- The Australian e-Health Research Centre, Health and Biosecurity, CSIRO, Brisbane, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.,Queensland Centre for Intellectual and Developmental Disability, The University of Queensland, Brisbane, Australia
| | - Paul B Colditz
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Perinatal Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Centre for Children's Health Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| |
Collapse
|
15
|
Jaimes C, Murcia DJ, Miguel K, DeFuria C, Sagar P, Gee MS. Identification of quality improvement areas in pediatric MRI from analysis of patient safety reports. Pediatr Radiol 2018; 48:66-73. [PMID: 29051964 DOI: 10.1007/s00247-017-3989-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/14/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Analysis of safety reports has been utilized to guide practice improvement efforts in adult magnetic resonance imaging (MRI). Data specific to pediatric MRI could help target areas of improvement in this population. OBJECTIVE To estimate the incidence of safety reports in pediatric MRI and to determine associated risk factors. MATERIALS AND METHODS In a retrospective HIPAA-compliant, institutional review board-approved study, a single-institution Radiology Information System was queried to identify MRI studies performed in pediatric patients (0-18 years old) from 1/1/2010 to 12/31/2015. The safety report database was queried for events matching the same demographic and dates. Data on patient age, gender, location (inpatient, outpatient, emergency room [ER]), and the use of sedation/general anesthesia were recorded. Safety reports were grouped into categories based on the cause and their severity. Descriptive statistics were used to summarize continuous variables. Chi-square analyses were performed for univariate determination of statistical significance of variables associated with safety report rates. A multivariate logistic regression was used to control for possible confounding effects. RESULTS A total of 16,749 pediatric MRI studies and 88 safety reports were analyzed, yielding a rate of 0.52%. There were significant differences in the rate of safety reports between patients younger than 6 years (0.89%) and those older (0.41%) (P<0.01), sedated (0.8%) and awake children (0.45%) (P<0.01), and inpatients (1.1%) and outpatients (0.4%) (P<0.01). The use of sedation/general anesthesia is an independent risk factor for a safety report (P=0.02). The most common causes for safety reports were service coordination (34%), drug reactions (19%), and diagnostic test and ordering errors (11%). CONCLUSION The overall rate of safety reports in pediatric MRI is 0.52%. Interventions should focus on vulnerable populations, such as younger patients, those requiring sedation, and those in need of acute medical attention.
Collapse
Affiliation(s)
- Camilo Jaimes
- Division of Neuroradiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Diana J Murcia
- Division of Abdominal Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Karen Miguel
- Quality and Safety Office, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Cathryn DeFuria
- Quality and Safety Office, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Pallavi Sagar
- Division of Pediatric Imaging, Department of Radiology, Massachusetts General Hospital for Children, Harvard Medical School, 55 Fruit St., Ellison 237, Boston, MA, 02114, USA
| | - Michael S Gee
- Division of Pediatric Imaging, Department of Radiology, Massachusetts General Hospital for Children, Harvard Medical School, 55 Fruit St., Ellison 237, Boston, MA, 02114, USA.
| |
Collapse
|
16
|
Cho HH, Kim IO, Cheon JE, Choi YH, Lee SM, Kim WS. Changes in brain magnetic resonance imaging patterns for preterm infants after introduction of a magnetic resonance-compatible incubator coil system: 5-year experience at a single institution. Eur J Radiol 2016; 85:1564-8. [PMID: 27501889 DOI: 10.1016/j.ejrad.2016.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 05/31/2016] [Accepted: 06/07/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the changes in using patterns of brain magnetic resonance imaging (MRI) in preterm infants after introduction of a MR-compatible incubator coil system. MATERIALS AND METHODS Brain MRIs for preterm infants with the MR-compatible incubator coil from March 2010 to July 2014 (n=154, group A) were compared with MRIs prior to the introduction of the incubator coil, from March 2005 to February 2010 (n=65, group B). Clinical data, MRI findings, acquisition time, and incidence of adverse events during the study were retrospectively reviewed. For the qualitative analysis of the examinations, the presence of motion artefact, spatial resolution, and overall image quality were assessed. Signal uniformity of each sequence was evaluated for a quantitative comparison. RESULTS Comparing with group B, Group A was significantly younger (36+3 vs. 38+3 weeks, p<0.001), had a significantly lower body weight (2006.6 and 2390.3g respectively; p<0.001) at the time of MRI, and had shorter time interval (54.3±2.6 vs. 70.5±4.4days, p=0.002) between birth and examination. Abnormal findings were noted more frequently in group A (n=100, 65%) than in B (n=24, 37%. p=0.001) with a significantly higher incidence of diffusion restriction (n=21, 13.6% vs. n=4, 6.2%, p=0.034). Mean image acquisition time was significantly shorter in group A (21.4±4.5 vs. 25.4±5.5min, p<0.001) with significant lower adverse events during MRI (n=26, 40 vs. n=6, 3.9%, p<0.001). Group A exhibited significantly less motion artefact, better spatial resolution, and better overall image quality with decreased signal variation than group B (all p<0.001). CONCLUSION Application of the MR-compatible incubator for preterm brain MRI evaluation is safer and provides more timely evaluation of preterm infants with better image quality.
Collapse
Affiliation(s)
- Hyun-Hae Cho
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - In-One Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, Republic of Korea.
| | - Jung-Eun Cheon
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, Republic of Korea
| | - Young Hun Choi
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, Republic of Korea
| | - So Mi Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea
| | - Woo Sun Kim
- Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, Republic of Korea; Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, 103 Daehak-ro, Jongno-gu, Seoul, 110-799, Republic of Korea
| |
Collapse
|
17
|
A quality improvement project to reduce hypothermia in infants undergoing MRI scanning. Pediatr Radiol 2016; 46:1187-98. [PMID: 27026025 DOI: 10.1007/s00247-016-3592-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 01/21/2016] [Accepted: 02/18/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Hypothermia prevention strategies during MRI scanning under general anesthesia in infants may pose a challenge due to the MRI scanner's technical constraints. Previous studies have demonstrated conflicting results related to increase or decrease in post-scan temperatures in children. We noted occurrences of post-scan hypothermia in anesthetized infants despite the use of routine passive warming techniques. OBJECTIVE The aims of our quality improvement project were (a) to identify variables associated with post-scan hypothermia in infants and (b) to develop and implement processes to reduce occurrence of hypothermia in neonatal intensive care unit (NICU) infants undergoing MRI. MATERIALS AND METHODS One hundred sixty-four infants undergoing MRI scanning were prospectively audited for post-scan body temperatures. A multidisciplinary team identified potential variables associated with post-scan hypothermia and designed preventative strategies: protocol development, risk factor identification, vigilance and use of a vacuum immobilizer. Another audit was performed, specifically focusing on NICU infants. RESULTS In the initial phase, we found that younger age (P = 0.002), lower weight (P = 0.005), lower pre-scan temperature (P < 0.01), primary anesthetic technique with propofol (P < 0.01), advanced airway devices (P = 0.02) and being in the NICU (P < 0.01) were associated with higher odds for developing post-scan decrease in body temperature. Quality improvement processes decreased the occurrence of hypothermia in NICU infants undergoing MRI scanning from 65% to 18% (95% confidence interval for the difference, 26-70%, P < 0.001). CONCLUSION Several variables, including being in the NICU, are associated with a decrease in post-scan temperature in infants undergoing MRI scanning under sedation/general anesthesia. Implementation of strategies to prevent hypothermia in infants may be challenging in the high-risk MRI environment. We were able to minimize this problem in clinical practice by applying quality improvement principles.
Collapse
|
18
|
George JM, Boyd RN, Colditz PB, Rose SE, Pannek K, Fripp J, Lingwood BE, Lai MM, Kong AHT, Ware RS, Coulthard A, Finn CM, Bandaranayake SE. PPREMO: a prospective cohort study of preterm infant brain structure and function to predict neurodevelopmental outcome. BMC Pediatr 2015; 15:123. [PMID: 26377791 PMCID: PMC4572671 DOI: 10.1186/s12887-015-0439-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 09/01/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND More than 50 percent of all infants born very preterm will experience significant motor and cognitive impairment. Provision of early intervention is dependent upon accurate, early identification of infants at risk of adverse outcomes. Magnetic resonance imaging at term equivalent age combined with General Movements assessment at 12 weeks corrected age is currently the most accurate method for early prediction of cerebral palsy at 12 months corrected age. To date no studies have compared the use of earlier magnetic resonance imaging combined with neuromotor and neurobehavioural assessments (at 30 weeks postmenstrual age) to predict later motor and neurodevelopmental outcomes including cerebral palsy (at 12-24 months corrected age). This study aims to investigate i) the relationship between earlier brain imaging and neuromotor/neurobehavioural assessments at 30 and 40 weeks postmenstrual age, and ii) their ability to predict motor and neurodevelopmental outcomes at 3 and 12 months corrected age. METHODS/DESIGN This prospective cohort study will recruit 80 preterm infants born ≤ 30 week's gestation and a reference group of 20 healthy term born infants from the Royal Brisbane & Women's Hospital in Brisbane, Australia. Infants will undergo brain magnetic resonance imaging at approximately 30 and 40 weeks postmenstrual age to develop our understanding of very early brain structure at 30 weeks and maturation that occurs between 30 and 40 weeks postmenstrual age. A combination of neurological (Hammersmith Neonatal Neurologic Examination), neuromotor (General Movements, Test of Infant Motor Performance), neurobehavioural (NICU Network Neurobehavioural Scale, Premie-Neuro) and visual assessments will be performed at 30 and 40 weeks postmenstrual age to improve our understanding of the relationship between brain structure and function. These data will be compared to motor assessments at 12 weeks corrected age and motor and neurodevelopmental outcomes at 12 months corrected age (neurological assessment by paediatrician, Bayley scales of Infant and Toddler Development, Alberta Infant Motor Scale, Neurosensory Motor Developmental Assessment) to differentiate atypical development (including cerebral palsy and/or motor delay). DISCUSSION Earlier identification of those very preterm infants at risk of adverse neurodevelopmental and motor outcomes provides an additional period for intervention to optimise outcomes. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12613000280707. Registered 8 March 2013.
Collapse
Affiliation(s)
- Joanne M George
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Australia.
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Australia.
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Australia.
| | - Paul B Colditz
- University of Queensland Centre for Clinical Research, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Stephen E Rose
- Digital Productivity Flagship, The Australian e-Health Research Centre, CSIRO, Brisbane, Australia.
| | - Kerstin Pannek
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Australia.
- Digital Productivity Flagship, The Australian e-Health Research Centre, CSIRO, Brisbane, Australia.
| | - Jurgen Fripp
- Digital Productivity Flagship, The Australian e-Health Research Centre, CSIRO, Brisbane, Australia.
| | - Barbara E Lingwood
- University of Queensland Centre for Clinical Research, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Melissa M Lai
- University of Queensland Centre for Clinical Research, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Annice H T Kong
- University of Queensland Centre for Clinical Research, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia.
| | - Robert S Ware
- School of Population Health, The University of Queensland, Brisbane, Australia.
- Queensland Children's Medical Research Institute, Children's Health Queensland Hospitals and Health Service, Brisbane, Australia.
| | - Alan Coulthard
- Royal Brisbane and Women's Hospital, Brisbane, Australia.
- Academic Discipline of Medical Imaging, School of Medicine, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Australia.
| | - Christine M Finn
- Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Australia.
| | - Sasaka E Bandaranayake
- Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Australia.
| |
Collapse
|
19
|
Plaisier A, Raets MMA, Ecury-Goossen GM, Govaert P, Feijen-Roon M, Reiss IKM, Smit LS, Lequin MH, Dudink J. Serial cranial ultrasonography or early MRI for detecting preterm brain injury? Arch Dis Child Fetal Neonatal Ed 2015; 100:F293-300. [PMID: 25637006 DOI: 10.1136/archdischild-2014-306129] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 01/10/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate detection ability and feasibility of serial cranial ultrasonography (CUS) and early MRI in preterm brain injury. DESIGN Prospective cohort study. SETTING Level III neonatal intensive care unit. PATIENTS 307 infants, born below 29 weeks of gestation. METHODS Serial CUS and MRI were performed according to standard clinical protocol. In case of instability, MRI was postponed or cancelled. Brain images were assessed by independent experts and compared between modalities. MAIN OUTCOME MEASURES Presence of preterm brain injury on either CUS or MRI and discrepant imaging findings on CUS and MRI. RESULTS Serial CUS was performed in all infants; early MRI was often postponed (n=59) or cancelled (n=126). Injury was found in 146 infants (47.6%). Clinical characteristics differed significantly between groups that were subdivided according to timing of MRI. 61 discrepant imaging findings were found. MRI was superior in identifying cerebellar haemorrhage; CUS in detection of acute intraventricular haemorrhage, perforator stroke and cerebral sinovenous thrombosis. CONCLUSIONS Advanced serial CUS seems highly effective in diagnosing preterm brain injury, but may miss cerebellar abnormalities. Although MRI does identify these lesions, feasibility is limited. Improved safety, better availability and tailored procedures are essential for MRI to increase its value in clinical care.
Collapse
Affiliation(s)
- Annemarie Plaisier
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center-Sophia, Rotterdam, The Netherlands Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marlou M A Raets
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center-Sophia, Rotterdam, The Netherlands
| | - Ginette M Ecury-Goossen
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center-Sophia, Rotterdam, The Netherlands
| | - Paul Govaert
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center-Sophia, Rotterdam, The Netherlands Department of Pediatrics, Koningin Paola Children's Hospital, Antwerp, Belgium
| | - Monique Feijen-Roon
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center-Sophia, Rotterdam, The Netherlands Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Irwin K M Reiss
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center-Sophia, Rotterdam, The Netherlands
| | - Liesbeth S Smit
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center-Sophia, Rotterdam, The Netherlands Division of Pediatric Neurology, Department of Neurology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Maarten H Lequin
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jeroen Dudink
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center-Sophia, Rotterdam, The Netherlands Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
20
|
Ureta-Velasco N, Martínez-de Aragón A, Moral-Pumarega M, Núñez-Enamorado N, Bergón-Sendín E, Pallás-Alonso C. Magnetic resonance imaging without sedation in neonates. An Pediatr (Barc) 2015. [DOI: 10.1016/j.anpede.2015.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
21
|
Ureta-Velasco N, Martínez-de Aragón A, Moral-Pumarega M, Núñez-Enamorado N, Bergón-Sendín E, Pallás-Alonso C. Resonancia magnética sin sedación en recién nacidos. An Pediatr (Barc) 2015; 82:354-9. [DOI: 10.1016/j.anpedi.2014.05.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 05/19/2014] [Accepted: 05/26/2014] [Indexed: 10/25/2022] Open
|
22
|
Tocchio S, Kline-Fath B, Kanal E, Schmithorst VJ, Panigrahy A. MRI evaluation and safety in the developing brain. Semin Perinatol 2015; 39:73-104. [PMID: 25743582 PMCID: PMC4380813 DOI: 10.1053/j.semperi.2015.01.002] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Magnetic resonance imaging (MRI) evaluation of the developing brain has dramatically increased over the last decade. Faster acquisitions and the development of advanced MRI sequences, such as magnetic resonance spectroscopy (MRS), diffusion tensor imaging (DTI), perfusion imaging, functional MR imaging (fMRI), and susceptibility-weighted imaging (SWI), as well as the use of higher magnetic field strengths has made MRI an invaluable tool for detailed evaluation of the developing brain. This article will provide an overview of the use and challenges associated with 1.5-T and 3-T static magnetic fields for evaluation of the developing brain. This review will also summarize the advantages, clinical challenges, and safety concerns specifically related to MRI in the fetus and newborn, including the implications of increased magnetic field strength, logistics related to transporting and monitoring of neonates during scanning, and sedation considerations, and a discussion of current technologies such as MRI conditional neonatal incubators and dedicated small-foot print neonatal intensive care unit (NICU) scanners.
Collapse
Affiliation(s)
- Shannon Tocchio
- Pediatric Imaging Research Center, Department of Radiology Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Beth Kline-Fath
- Department of Radiology Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Emanuel Kanal
- Director, Magnetic Resonance Services; Professor of Neuroradiology; Department of Radiology, University of Pittsburgh Medical Center (UPMC)
| | - Vincent J. Schmithorst
- Pediatric Imaging Research Center, Department of Radiology Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Ashok Panigrahy
- Pediatric Imaging Research Center, Department of Radiology Children׳s Hospital of Pittsburgh of UPMC, University of Pittsburgh Medical Center, Pittsburgh, PA.
| |
Collapse
|
23
|
Ecury-Goossen GM, Camfferman FA, Leijser LM, Govaert P, Dudink J. State of the art cranial ultrasound imaging in neonates. J Vis Exp 2015:e52238. [PMID: 25742241 DOI: 10.3791/52238] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Cranial ultrasound (CUS) is a reputable tool for brain imaging in critically ill neonates. It is safe, relatively cheap and easy to use, even when a patient is unstable. In addition it is radiation-free and allows serial imaging. CUS possibilities have steadily expanded. However, in many neonatal intensive care units, these possibilities are not optimally used. We present a comprehensive approach for neonatal CUS, focusing on optimal settings, different probes, multiple acoustic windows and Doppler techniques. This approach is suited for both routine clinical practice and research purposes. In a live demonstration, we show how this technique is performed in the neonatal intensive care unit. Using optimal settings and probes allows for better imaging quality and improves the diagnostic value of CUS in experienced hands. Traditionally, images are obtained through the anterior fontanel. Use of supplemental acoustic windows (lambdoid, mastoid, and lateral fontanels) improves detection of brain injury. Adding Doppler studies allows screening of patency of large intracranial arteries and veins. Flow velocities and indices can be obtained. Doppler CUS offers the possibility of detecting cerebral sinovenous thrombosis at an early stage, creating a window for therapeutic intervention prior to thrombosis-induced tissue damage. Equipment, data storage and safety aspects are also addressed.
Collapse
Affiliation(s)
| | | | - Lara M Leijser
- Department of Pediatrics, Division of Neonatology, UZ Brussel; Department of Pediatrics, Division of Neonatology, Leiden University Medical Center
| | - Paul Govaert
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital; Department of Pediatrics, Division of Neonatology, Isala Hospital
| | - Jeroen Dudink
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital; Department of Radiology, Erasmus MC-Sophia Children's Hospital;
| |
Collapse
|
24
|
Practical planning to maintain premature infants' safety during magnetic resonance imaging: a systematic review. Adv Neonatal Care 2015; 15:23-37; quiz E1-2. [PMID: 25626980 DOI: 10.1097/anc.0000000000000142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) makes a significant contribution to diagnose brain injury in premature infants and is a diagnostic procedure that requires the infant to be taken out of the controlled environment established for growth and development. To ensure safe procedures for these vulnerable patients, practical planning and surveillance are paramount. PURPOSE This systematic review summarizes and evaluates the literature reporting on practical planning to maintain required safety for premature infants undergoing MRI. METHODS Literature identified through various search strategies was screened, abstracted, appraised, and synthesized through a descriptive analysis. Thirteen research studies, 2 quality improvement projects, and 10 other documents, including practice guidelines, general reviews and articles, a book chapter, and an editorial article, were retained for in-depth review. CONCLUSIONS Various procedures and equipment to ensure the safety of premature infants during MRI have been developed and tested. Although the results are promising and increasingly consistent, our review suggests that more research is needed before conclusive recommendations for the use of magnetic resonance-compatible incubators, the "feed-and-sleep" approach to avoid sedation, or the specific noise-cancelling ear protection for the premature infants' safety during MRI can be established.
Collapse
|
25
|
van der Starre C, van Dijk M, van den Bos A, Tibboel D. Paediatric critical incident analysis: lessons learnt on analysis, recommendations and implementation. Eur J Pediatr 2014; 173:1449-57. [PMID: 24878871 DOI: 10.1007/s00431-014-2341-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 05/14/2014] [Accepted: 05/19/2014] [Indexed: 11/26/2022]
Abstract
UNLABELLED The objectives of this study were to identify causal and contributing factors of serious patient safety incidents in a paediatric university hospital, to report on ensuing recommendations and to assess the extent of implementation of the recommendations. The possible causal and contributing factors identified in 17 incidents were classified by a system devised by Vincent et al. Proposed recommendations were classified by the same system, and degrees of implementation were established. A median of 5 causal and contributing factors per incident were identified. Twenty-two percent of all factors were related to teamwork and 22 % to task factors. A median of 5 recommendations per analysis were formulated. Most recommendations were related to task factors (36 %). The time load of each analysis was a mean of 27 h. One third of the recommendations have been acted upon, mostly those related to task and team factors. CONCLUSION Incident analysis is time-consuming but yields indispensable information on causal and contributing factors, presenting numerous opportunities for quality improvement. The value of these analyses could be improved by appointing responsibilities and setting up time frames for implementation. A bottom-up approach with managerial support appears to be a key to turning incident analysis and quality improvement into an ongoing process.
Collapse
Affiliation(s)
- Cynthia van der Starre
- Intensive Care Unit, Erasmus MC Sophia Children's Hospital, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands,
| | | | | | | |
Collapse
|
26
|
Plaisier A, Pieterman K, Lequin MH, Govaert P, Heemskerk AM, Reiss IKM, Krestin GP, Leemans A, Dudink J. Choice of diffusion tensor estimation approach affects fiber tractography of the fornix in preterm brain. AJNR Am J Neuroradiol 2014; 35:1219-25. [PMID: 24407271 DOI: 10.3174/ajnr.a3830] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Neonatal DTI enables quantitative assessment of microstructural brain properties. Although its use is increasing, it is not widely known that vast differences in tractography results can occur, depending on the diffusion tensor estimation methodology used. Current clinical work appears to be insufficiently focused on data quality and processing of neonatal DTI. To raise awareness about this important processing step, we investigated tractography reconstructions of the fornix with the use of several estimation techniques. We hypothesized that the method of tensor estimation significantly affects DTI tractography results. MATERIALS AND METHODS Twenty-eight DTI scans of infants born <29 weeks of gestation, acquired at 30-week postmenstrual age and without intracranial injury observed, were prospectively collected. Four diffusion tensor estimation methods were applied: 1) linear least squares; 2) weighted linear least squares; 3) nonlinear least squares, and 4) robust estimation of tensors by outlier rejection. Quality of DTI data and tractography results were evaluated for each method. RESULTS With nonlinear least squares and robust estimation of tensors by outlier rejection, significantly lower mean fractional anisotropy values were obtained than with linear least squares and weighted linear least squares. Visualized quality of tract reconstruction was significantly higher by use of robust estimation of tensors by outlier rejection and correlated with quality of DTI data. CONCLUSIONS Quality assessment and choice of processing methodology have considerable impact on neonatal DTI analysis. Dedicated acquisition, quality assessment, and advanced processing of neonatal DTI data must be ensured before performing clinical analyses, such as associating microstructural brain properties with patient outcome.
Collapse
Affiliation(s)
- A Plaisier
- From the Division of Neonatology, Department of Pediatrics (A.P., K.P., P.G., A.M.H., J.D.), Erasmus Medical Center-Sophia, Rotterdam, The NetherlandsDepartments of Radiology (A.P., M.H.L., A.M.H., G.P.K., J.D.)
| | - K Pieterman
- From the Division of Neonatology, Department of Pediatrics (A.P., K.P., P.G., A.M.H., J.D.), Erasmus Medical Center-Sophia, Rotterdam, The Netherlands
| | - M H Lequin
- Departments of Radiology (A.P., M.H.L., A.M.H., G.P.K., J.D.)
| | - P Govaert
- From the Division of Neonatology, Department of Pediatrics (A.P., K.P., P.G., A.M.H., J.D.), Erasmus Medical Center-Sophia, Rotterdam, The NetherlandsDepartment of Pediatrics (P.G.), Koningin Paola Children's Hospital, Antwerp, Belgium
| | - A M Heemskerk
- From the Division of Neonatology, Department of Pediatrics (A.P., K.P., P.G., A.M.H., J.D.), Erasmus Medical Center-Sophia, Rotterdam, The NetherlandsDepartments of Radiology (A.P., M.H.L., A.M.H., G.P.K., J.D.)
| | - I K M Reiss
- Neonatology (I.K.M.R.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - G P Krestin
- Departments of Radiology (A.P., M.H.L., A.M.H., G.P.K., J.D.)
| | - A Leemans
- Image Sciences Institute (A.L.), University Medical Center Utrecht, Utrecht, The Netherlands
| | - J Dudink
- From the Division of Neonatology, Department of Pediatrics (A.P., K.P., P.G., A.M.H., J.D.), Erasmus Medical Center-Sophia, Rotterdam, The NetherlandsDepartments of Radiology (A.P., M.H.L., A.M.H., G.P.K., J.D.)
| |
Collapse
|
27
|
Raets MMA, Sol JJ, Govaert P, Lequin MH, Reiss IKM, Kroon AA, Appel IM, Dudink J. Serial Cranial US for Detection of Cerebral Sinovenous Thrombosis in Preterm Infants. Radiology 2013. [DOI: 10.1148/radiology.13130401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
28
|
Raets MMA, Sol JJ, Govaert P, Lequin MH, Reiss IKM, Kroon AA, Appel IM, Dudink J. Serial cranial US for detection of cerebral sinovenous thrombosis in preterm infants. Radiology 2013; 269:879-86. [PMID: 23985276 DOI: 10.1148/radiol.13130401] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To report the incidence of cerebral sinovenous thrombosis (CSVT) in a prospective cohort of preterm infants with a gestational age of less than 29 weeks. MATERIALS AND METHODS The local medical ethics review board approved this study, and written parental consent was obtained. Preterm infants with a gestational age of less than 29 weeks who were admitted to the neonatal intensive care unit were prospectively studied with cranial ultrasonography (US). The scanning protocol included visualization with color Doppler imaging of the superior sagittal sinus and transverse sinuses through the anterior (8.5-MHz probe) and mastoid (13-MHz probe) fontanelles. When feasible, magnetic resonance imaging was performed to confirm cranial US-diagnosed CSVT. The differences between preterm infants with and those without CSVT were analyzed by using Mann-Whitney tests for continuous variables and Fisher exact tests for categorical data. RESULTS Cranial US was used to document CSVT in 11 of 249 preterm infants with a gestational age of less than 29 weeks. Transverse sinuses were most frequently affected (in all 11 patients with CSVT). All infants with CSVT were asymptomatic. Postnatal age at diagnosis ranged from 5 to 34 days. The mean gestational age was significantly lower in infants with CSVT (25.9 weeks vs 26.8 weeks, P = .038). Of the risk factors studied, only duration of mechanical ventilation was associated with CSVT; it was significantly longer in the CSVT group. CONCLUSION Systematic serial cranial US of infants with a gestational age of less than 29 weeks showed a remarkably high incidence of CSVT of 4.4%. Cranial US including color Doppler imaging with scans obtained through the mastoid fontanelle can depict CSVT at an early stage. Treatment of this possibly important condition needs attention.
Collapse
Affiliation(s)
- Marlou M A Raets
- From the Departments of Neonatology (M.M.A.R., J.J.S., P.G., I.K.M.R., A.A.K., J.D.), Pediatric Radiology (M.H.L., J.D.), and Hematology (I.M.A.), Erasmus MC-Sophia Children's Hospital Rotterdam, Dr Molewaterplein 60, 3015 GJ Rotterdam, the Netherlands; and Department of Pediatrics, Koningin Paola Children's Hospital, Antwerp, Belgium (P.G.)
| | | | | | | | | | | | | | | |
Collapse
|
29
|
Lane A, Chuk LMR, Colditz PB, Coulthard A. The MRI-compatible neonatal incubator in practice. J Paediatr Child Health 2013; 49:E377-80. [PMID: 23678957 DOI: 10.1111/jpc.12222] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Annah Lane
- Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | | | | | | |
Collapse
|
30
|
Plaisier A, Govaert P, Lequin MH, Dudink J. Optimal timing of cerebral MRI in preterm infants to predict long-term neurodevelopmental outcome: a systematic review. AJNR Am J Neuroradiol 2013; 35:841-7. [PMID: 23639558 DOI: 10.3174/ajnr.a3513] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
SUMMARY Advances in neonatal neuroimaging have improved detection of preterm brain injury responsible for abnormal neuromotor and cognitive development. Increasingly sophisticated MR imaging setups allow scanning during early preterm life. In this review, we investigated how brain MR imaging in preterm infants should be timed to best predict long-term outcome. Given the strong evidence that structural brain abnormalities are related to long-term neurodevelopment, MR imaging should preferably be performed at term-equivalent age. Early MR imaging is promising because it can guide early intervention studies and is indispensable in research on preterm brain injury.
Collapse
Affiliation(s)
- A Plaisier
- From the Division of Neonatology (A.P., P.G., J.D.)Department of Pediatrics, and Division of Pediatric Radiology (A.P., M.H.L., J.D.), Department of Radiology, Erasmus Medical Center-Sophia, Rotterdam, the Netherlands
| | - P Govaert
- From the Division of Neonatology (A.P., P.G., J.D.)Department of Pediatrics (P.G.), Koningin Paola Children's Hospital, Antwerp, Belgium
| | - M H Lequin
- Department of Pediatrics, and Division of Pediatric Radiology (A.P., M.H.L., J.D.), Department of Radiology, Erasmus Medical Center-Sophia, Rotterdam, the Netherlands
| | - J Dudink
- From the Division of Neonatology (A.P., P.G., J.D.)Department of Pediatrics, and Division of Pediatric Radiology (A.P., M.H.L., J.D.), Department of Radiology, Erasmus Medical Center-Sophia, Rotterdam, the Netherlands
| |
Collapse
|
31
|
Heemskerk AM, Leemans A, Plaisier A, Pieterman K, Lequin MH, Dudink J. Acquisition guidelines and quality assessment tools for analyzing neonatal diffusion tensor MRI data. AJNR Am J Neuroradiol 2013; 34:1496-505. [PMID: 23518355 DOI: 10.3174/ajnr.a3465] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Diffusion tensor imaging is a valuable measure in clinical settings to assess diagnosis and prognosis of neonatal brain development. However, obtaining reliable images is not straightforward because of the tissue characteristics of the neonatal brain and the high likelihood of motion artifacts. In this review, we present guidelines on how to acquire DTI data of the neonatal brain and recommend high-quality data acquisition and processing as an essential means to obtain accurate and robust parametric maps. Sudden head movements are problematic for DTI in neonates, and these may lead to incorrect values. We describe strategies to minimize the corrupting effects both in terms of acquisition (eg, more gradient directions) and postprocessing (eg, tensor estimation methods). In addition, tools are described that can help assess whether a dataset is of sufficient quality for further assessment.
Collapse
Affiliation(s)
- A M Heemskerk
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | | | | | | |
Collapse
|