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Greer MLC, Gee MS, Pace E, Sotardi S, Morin CE, Chavhan GB, Jaimes C. A survey of non-sedate practices when acquiring pediatric magnetic resonance imaging examinations. Pediatr Radiol 2024; 54:239-249. [PMID: 38112762 DOI: 10.1007/s00247-023-05828-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Improving access to magnetic resonance imaging (MRI) in childhood can be facilitated by making it faster and cheaper and reducing need for sedation or general anesthesia (GA) to mitigate motion. Some children achieve diagnostic quality MRI without GA through the use of non- practices fostering their cooperation and/or alleviating anxiety. Employed before and during MRI, these variably educate, distract, and/or desensitize patients to this environment. OBJECTIVE To assess current utilization of non-sedate practices in pediatric MRI, including variations in practice and outcomes. MATERIALS AND METHODS A survey-based study was conducted with 1372 surveys emailed to the Society for Pediatric Radiology members in February 2021, inviting one response per institution. RESULTS Responses from 50 unique institutions in nine countries revealed 49/50 (98%) sites used ≥ 1 non-sedate practice, 48/50 (96%) sites in infants < 6 months, and 11/50 (22%) for children aged 6 months to 3 years. Non-sedate practices per site averaged 4.5 (range 0-10), feed and swaddle used at 47/49 (96%) sites, and child life specialists at 35/49 (71%). Average success rates were moderate (> 50-75%) across all sites and high (> 75-100%) for 20% of sites, varying with specific techniques. Commonest barriers to use were scheduling conflicts and limited knowledge. CONCLUSION Non-sedate practice utilization in pediatric MRI was near-universal but widely variable across sites, ages, and locales, with room for broader adoption. Although on average non-sedate practice success rates were similar, the range in use and outcomes suggest a need for standardized implementation guidelines, including patient selection and outcome metrics, to optimize utilization and inform educational initiatives.
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Affiliation(s)
- Mary-Louise C Greer
- Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada.
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Erika Pace
- Department of Radiology, Royal Marsden NHS Foundation Trust, London, England, UK
| | - Susan Sotardi
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Cara E Morin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Govind B Chavhan
- Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Department of Medical Imaging, University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Camilo Jaimes
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Lepus CA, Moote DJ, Bao S, Mosha MH, Hyams JS. Simplified Magnetic Resonance Index of Activity Is Useful for Terminal Ileal but not Colonic Disease in Pediatric Crohn Disease. J Pediatr Gastroenterol Nutr 2022; 74:610-616. [PMID: 35149649 DOI: 10.1097/mpg.0000000000003412] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Ileocolonoscopy (IC) detects mucosal inflammation and magnetic resonance enterography (MRE) detects transmural inflammation in Crohn disease (CD). We aimed to evaluate the relationship between the simplified magnetic resonance index of activity (MARIAs) and measures of inflammation by IC in children with newly diagnosed CD. METHODS Retrospective review of 140 patients 6-18 years of age with CD who had baseline IC and MRE within 5 weeks of diagnosis. MARIAs was calculated for each intestinal segment (terminal ileum [TI], ascending colon, transverse colon, descending colon, sigmoid colon, rectum), defined as (1 × thickness > 3 mm) + (1 × edema) + (1 × fat stranding) + (2 × ulcers). Sensitivity and specificity were derived using receiver operating characteristic (ROC) curves to compare MARIAs to IC findings. RESULTS Using IC as the reference standard, the cutoff MARIAs ≥1 identified TI segments with active inflammation with 84% sensitivity, 73% specificity, 85% positive predictive value (PPV), 70% negative predictive value (NPV), and area under the curve (AUC) 0.782 (95% confidence interval [CI] 0.689-0.876). The cutoff MARIAs ≥2 identified TI segments with severe lesions with 87% sensitivity, 76% specificity, 87% PPV, 76% NPV, and AUC 0.814 (95% CI 0.712-0.916). There was poor sensitivity for all colonic segments. CONCLUSION The MARIAs is feasible and accurate in reflecting disease activity in the TI, but not in the colon, in children with newly diagnosed CD. Although the MARIAs may be useful for monitoring TI disease activity over time, full assessment continues to require both IC and MRE.
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Affiliation(s)
- Chelsea A Lepus
- Connecticut Children's Medical Center, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Hartford; University of Connecticut School of Medicine, Department of Pediatrics, Farmington
| | - Douglas J Moote
- Connecticut Children's Medical Center, Division of Pediatric Radiology
| | - Shanshan Bao
- Connecticut Children's Medical Center, Division of Pediatric Radiology
| | - Maua H Mosha
- Connecticut Children's Medical Center, Department of Research, Hartford, CT
| | - Jeffrey S Hyams
- Connecticut Children's Medical Center, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Hartford; University of Connecticut School of Medicine, Department of Pediatrics, Farmington
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3
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Al-Sarhani H, Gottumukkala RV, Grasparil ADS, Tung EL, Gee MS, Greer MLC. Screening of cancer predisposition syndromes. Pediatr Radiol 2022; 52:401-417. [PMID: 33791839 DOI: 10.1007/s00247-021-05023-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/14/2021] [Accepted: 02/17/2021] [Indexed: 12/19/2022]
Abstract
Pediatric patients with cancer predisposition syndromes are at increased risk of developing malignancies compared with their age-matched peers, necessitating regular surveillance. Screening protocols differ among syndromes and are composed of a number of elements, imaging being one. Surveillance can be initiated in infants, children and adolescents with a tumor known or suspected of being related to a cancer predisposition syndrome or where genetic testing identifies a germline pathogenic gene variant in an asymptomatic child. Pre-symptomatic detection of malignant neoplasms offers potential to improve treatment options and survival outcomes, but the benefits and risks of screening need to be weighed, particularly with variable penetrance in many cancer predisposition syndromes. In this review we discuss the benefits and risks of surveillance imaging and the importance of integrating imaging and non-imaging screening elements. We explore the principles of surveillance imaging with particular reference to whole-body MRI, considering the strategies to minimize false-negative and manage false-positive whole-body MRI results, the value of standardized nomenclature when reporting risk stratification to better guide patient management, and the need for timely communication of results to allay anxiety. Cancer predisposition syndrome screening is a multimodality, multidisciplinary and longitudinal process, so developing formalized frameworks for surveillance imaging programs should enhance diagnostic performance while improving the patient experience.
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Affiliation(s)
- Haifa Al-Sarhani
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Ravi V Gottumukkala
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Angelo Don S Grasparil
- Department of Radiological Sciences, Cardinal Santos Medical Center, San Juan City, Philippines
| | - Eric L Tung
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mary-Louise C Greer
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada. .,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
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Pillai RLI. We All Need a Little TLC: An Argument for an Increased Role of Child Life Services in Patient Care and Medical Education. Hosp Pediatr 2020; 10:913-917. [PMID: 32887731 PMCID: PMC7521939 DOI: 10.1542/hpeds.2020-0119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Child life services (CLS) was created through a synthesis of developmental psychology, a recognition of the inherent difficulties of a hospital environment, and a desire to improve the patient experience of children. Many of the principles of CLS can be applied to other patients as well. In this article, the history of CLS is briefly surveyed, followed by a review of the successes of CLS in the hospital. An argument for an increased role for CLS in medical education and the development of a Program for Adult Life Services is then proposed.
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Abdominal Applications of Pediatric Body MR Angiography: Tailored Optimization for Successful Outcome. AJR Am J Roentgenol 2020; 215:206-214. [PMID: 32374667 DOI: 10.2214/ajr.19.22289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE. The purpose of this article is to summarize current common techniques and indications for pediatric abdominopelvic MR angiography and strategies for optimizing them to achieve successful outcomes. We also discuss newer MR angiography techniques, including whole-body imaging and blood pool contrast agents, as well as various approaches to reducing the need for anesthesia in pediatric MRI. CONCLUSION. Pediatric body vascular imaging presents a unique set of challenges that require a tailored approach. Emerging pediatric abdominopelvic MR angiography techniques hold promise for continued improvement in pediatric body MR angiography.
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Rudder BS, Easley SJ, Robinson AL, Noel-MacDonnell JR, Nielsen DB. Effects of an MRI Try Without program on patient access. Pediatr Radiol 2019; 49:1712-1717. [PMID: 31392365 DOI: 10.1007/s00247-019-04487-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/09/2019] [Accepted: 07/29/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Pediatric patients are often sedated for magnetic resonance imaging (MRI) scans to ensure images are of diagnostic quality. However, access time for MRIs requiring sedation is often long due to high patient volumes and limited sedation resources. OBJECTIVE This study examined the effectiveness of an MRI Try Without sedation program to decrease the wait time for obtaining an MRI while simultaneously ensuring diagnostic-quality images. MATERIALS AND METHODS A retrospective chart review was performed on subjects who utilized the MRI Try Without program from April 2014 through June 2015 at a dedicated pediatric institution. Child life specialist preparations and access time (i.e. time from exam ordered to exam completed) were recorded in each patient's electronic medical record. MRI images were evaluated for image quality by a pediatric neuroradiologist. RESULTS A total of 134 patients participated in the MRI Try Without program (mean age: 6.9±1.7 years), all of whom received interventions from a child life specialist. The average number of days between when the order was placed and when the MRI was completed using the MRI Try Without program was 15.4±18.5 days, while the third-available appointment for sedation/anesthesia was 46.2 days (standard deviation [SD]±15.7 days). Nearly all patients received a "good" or "very good" image quality determination (87.3%) and only 5 (3.8%) patients were recommended for repeat examination for diagnostic-quality images. CONCLUSION Utilization of an MRI Try Without sedation program, with child life specialist interventions, decreased the wait time for obtaining an MRI while still providing diagnostic-quality images.
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Affiliation(s)
- Barbra S Rudder
- Child Life Department, Children's Mercy, 2401 Gillham Road, Kansas City, MO, 64108, USA.
| | - Sara J Easley
- Child Life Department, Children's Mercy, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Amie L Robinson
- Department of Radiology, Children's Mercy, Kansas City, MO, USA
| | | | - David B Nielsen
- Department of Radiology, Children's Mercy, Kansas City, MO, USA
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Xu HS, Cavaliere RM, Min RJ. Transforming the Imaging Experience While Decreasing Sedation Rates. J Am Coll Radiol 2019; 17:46-52. [PMID: 31570312 DOI: 10.1016/j.jacr.2019.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/23/2019] [Accepted: 08/05/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the effect of the MRI-am-a-Hero program on sedation utilization for outpatient pediatric MRI studies. METHODS The MRI-am-a-Hero program, which utilizes multimedia educational material and popular comic book characters to educate and support pediatric patients during MRI scan, was implemented at the radiology facility of a single tertiary care, academic medical center. The effect of the MRI-am-a-Hero program on sedation utilization for pediatric MRI was retrospectively evaluated using multivariate regressions yielding odds ratio of sedation before and after program implementation. The institutional review board approved the study with HIPAA compliancy. Effectiveness of the program was evaluated while controlling for age, neurological MRI examination, number of examinations in the case, and use of intravenous contrast. Further analysis was performed in subgroups categorized by age, neurological MRI versus nonneurological MRI, and the use of contrast. RESULTS The percent of MRI cases with sedation decreased from 22.9% to 17.3% after the MRI-am-a-Hero program was implemented. When controlling for other variables, including patient age, neurological MRI, number of examinations in a case, and use of intravenous contrast, the odds of a study being performed with sedation after program implementation are 40% less than the odds before program implementation (odds ratio [OR] 0.60, P < .001). The effect of the program was greatest for patients aged 4 to 7 (OR 0.56, P < .001), followed by patients aged 8 to 11 (OR 0.64, P = .019). It was not statistically significant for patients aged 12 to 15 (OR 0.97, P = .919). CONCLUSION MRI-am-a-Hero is a generalizable and inexpensive program for reducing sedation utilization for outpatient pediatric MRI studies, especially for patients aged 4 to 11.
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Affiliation(s)
- Helen S Xu
- Weill Cornell Imaging at NewYork-Presbyterian, New York, New York
| | | | - Robert J Min
- Weill Cornell Imaging at NewYork-Presbyterian, New York, New York.
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Watson TA, Petit P, Augdal TA, Avni EF, Bruno C, Damasio MB, Darge K, Kjucevsek D, Franchi-Abella S, Ibe D, Littooij A, Lobo L, Mentzel HJ, Napolitano M, Ntoulia A, Riccabona M, Stafrace S, Wozniak M, Ording Müller LS. European Society of Paediatric Radiology abdominal imaging task force: statement on imaging in very early onset inflammatory bowel disease. Pediatr Radiol 2019; 49:841-848. [PMID: 30915515 DOI: 10.1007/s00247-019-04375-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Very early onset inflammatory bowel disease (VEO-IBD) is defined as disease presenting before the age of 6. These children require a tailored imaging approach because conventional imaging studies can be difficult to perform at such a young age. Unlike inflammatory bowel disease in older children and adults, colonic disease predominates in VEO-IBD, and small-bowel disease is rare. Distinguishing Crohn disease from ulcerative colitis is challenging both clinically and on histology. Radiology offers the greatest utility for detecting small-bowel disease because it helps to distinguish the two main disease entities and guide clinical management. Small-bowel ultrasound is recommended as the first-line investigation because it requires relatively little preparation, is readily available and is generally well tolerated in young children. We present these recommendations, based on the current evidence for radiologic management in this group, and propose an imaging algorithm for investigating VEO-IBD.
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Affiliation(s)
- Tom A Watson
- Department of Radiology,, Great Ormond Street Hospital for Children NHS Foundation Trust,, Great Ormond Street, London, WC1N 3JH, UK.
| | - Philippe Petit
- Service d'Imagerie Pédiatrique et Prénatale, Hôpital Timone Enfants, Marseille, France
| | - Thomas A Augdal
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - E Fred Avni
- Department of Pediatric Radiology, Jeanne de Flandre Hospital, CHRU de Lille, Lille, France
| | - Costanza Bruno
- Department of Radiology, Radiology Institute,, Verona, Italy
| | | | - Kassa Darge
- Department of Radiology, The Children's Hospital of Philadelphia, University of Pennsylvania,, Philadelphia, PA, USA
| | - Damjana Kjucevsek
- Department of Diagnostic Imaging, University Children's Hospital, Ljubljana, Slovenia
| | - Stéphanie Franchi-Abella
- Department of Paediatric Radiology, Hôpital Bicêtre - Hôpitaux Universitaires Paris-Sud, Université Paris-Sud,, Orsay, France
| | - Donald Ibe
- Department of Radiology,, Ahmadu Bello University Teaching Hospital Shika,, Zaria, Kaduna, Nigeria
| | - Annemieke Littooij
- Princess Maxima Center for Pediatric Oncology, Wilhelmina Children's Hospital Utrecht/UMCU,, Utrecht, the Netherlands
| | - Luisa Lobo
- Department of Radiology, Hospital de Santa Maria-CHLN, University Hospital,, Lisbon, Portugal
| | - Hans J Mentzel
- Section of Pediatric Radiology, Institute of Diagnostic and Interventional Radiology, University Hospital Jena,, Jena, Germany
| | - Marcelo Napolitano
- Department of Paediatric Radiology and Neuroradiology,, V. Buzzi Children's Hospital,, Milan, Italy
| | | | - Michael Riccabona
- Department of Radiology, Division of Pediatric Radiology, University Hospital Graz,, Graz, Austria
| | | | - Magdalena Wozniak
- Department of Pediatric Radiology, Medical University of Lublin, Lublin, Poland
| | - Lil-Sofie Ording Müller
- Department of Radiology and Nuclear Medicine, Unit for Paediatric Radiology, Oslo University Hospital, Oslo, Norway
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Son JK, Ali S, Al Khori N, Lee EY. MR Imaging Evaluation of Pediatric Genital Disorders:. Magn Reson Imaging Clin N Am 2019; 27:301-321. [DOI: 10.1016/j.mric.2019.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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10
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MR Imaging Evaluation of Inflammatory Bowel Disease in Children:: Where Are We Now in 2019. Magn Reson Imaging Clin N Am 2019; 27:291-300. [PMID: 30910099 DOI: 10.1016/j.mric.2019.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Inflammatory bowel disease (IBD) is an important cause of abdominal pain in the pediatric population. Magnetic resonance enterography (MRE) plays a crucial role in assessment of disease severity, location, extent of disease, and assessment for associated complications. As MR imaging technology has advanced, new techniques have been brought into clinical practice. Recent research has expanded our understanding of how the inflammatory processes in IBD manifest on MRE and improved radiology's ability to accurately assess the disease and its associated complications. This article discusses up-to-date MR imaging techniques and imaging manifestations of IBD in pediatric patients.
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11
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Barber J, Shah N, Watson T. Early onset inflammatory bowel disease – What the radiologist needs to know. Eur J Radiol 2018; 106:173-182. [DOI: 10.1016/j.ejrad.2018.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/15/2018] [Accepted: 07/02/2018] [Indexed: 02/07/2023]
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Barkovich MJ, Xu D, Desikan RS, Williams C, Barkovich AJ. Pediatric neuro MRI: tricks to minimize sedation. Pediatr Radiol 2018; 48:50-55. [PMID: 28432404 PMCID: PMC5651215 DOI: 10.1007/s00247-017-3785-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 11/30/2016] [Accepted: 01/26/2017] [Indexed: 02/03/2023]
Abstract
Magnetic resonance imaging (MRI) is the workhorse modality in pediatric neuroimaging because it provides excellent soft-tissue contrast without ionizing radiation. Until recently, studies were uninterpretable without sedation; however, given development of shorter sequences, sequences that correct for motion, and studies showing the potentially deleterious effects of sedation on immature laboratory animals, it is prudent to minimize sedation when possible. This manuscript provides basic guidelines for performing pediatric neuro MRI without sedation by both modifying technical factors to reduce scan time and noise, and using a multi-disciplinary team to coordinate imaging with the patient's biorhythms.
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Affiliation(s)
- Matthew J. Barkovich
- Department of Radiology and Diagnostic Imaging, University of California, San Francisco, 505 Parnassus Ave., Room L352, San Francisco, CA 94143-0628, USA
| | - Duan Xu
- Department of Radiology and Diagnostic Imaging, University of California, San Francisco, 505 Parnassus Ave., Room L352, San Francisco, CA 94143-0628, USA,Department of Radiology UCSF-Benioff Children’s Hospital San Francisco, CA, USA
| | - Rahul S. Desikan
- Department of Radiology and Diagnostic Imaging, University of California, San Francisco, 505 Parnassus Ave., Room L352, San Francisco, CA 94143-0628, USA
| | - Cassandra Williams
- Department of Radiology UCSF-Benioff Children’s Hospital San Francisco, CA, USA
| | - A. James Barkovich
- Department of Radiology and Diagnostic Imaging, University of California, San Francisco, 505 Parnassus Ave., Room L352, San Francisco, CA 94143-0628, USA,Department of Radiology UCSF-Benioff Children’s Hospital San Francisco, CA, USA
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Yoon HM, Suh CH, Kim JR, Lee JS, Jung AY, Kim KM, Cho YA. Diagnostic Performance of Magnetic Resonance Enterography for Detection of Active Inflammation in Children and Adolescents With Inflammatory Bowel Disease: A Systematic Review and Diagnostic Meta-analysis. JAMA Pediatr 2017; 171:1208-1216. [PMID: 29052734 PMCID: PMC6583777 DOI: 10.1001/jamapediatrics.2017.3400] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 07/08/2017] [Indexed: 12/13/2022]
Abstract
Importance Magnetic resonance (MR) enterography has the advantage over other techniques of being noninvasive, lacking ionizing radiation, and demonstrating excellent soft-tissue contrast to evaluate pediatric patients with inflammatory bowel disease (IBD). Objective To evaluate the diagnostic performance of MR enterography for detection of active inflammation in children and adolescents with known or suspected IBD. Data Sources A search of MEDLINE and EMBASE up to January 2, 2017, was performed to identify studies. Search terms included child, pediatric, adolescent, Crohn disease, inflammatory bowel disease, and magnetic resonance enterography. The search was limited to English-language publications. Study Selection Studies evaluating the diagnostic performance of MR enterography for detection of active inflammation in pediatric patients with known or suspected IBD were selected. Two reviewers independently assessed the eligibility of the selected articles. Data Extraction and Synthesis The study was performed and reported in accordance with the PRISMA guidelines. Pooled summary estimates of sensitivity and specificity were calculated using hierarchical logistic regression modeling. Main Outcomes and Measures The diagnostic performance of MR enterography for detection of active inflammation in pediatric patients with known or suspected IBD was the primary outcome. Subgroup analyses and meta-regression were performed. Results Eighteen original articles involving a total of 687 patients were included. The summary sensitivity was 83% (95% CI, 75%-89%), the summary specificity was 93% (95% CI, 90%-95%), and the area under the hierarchical summary receiver operating characteristic curve was 0.95 (95% CI, 0.93-0.97). The Higgins I2 statistics demonstrated substantial heterogeneity in terms of sensitivity (I2 = 84.1%) and specificity (I2 = 68.8%). Based on per-patient analysis, the summary sensitivity was 86% (95% CI, 78%-91%) and specificity was 91% (95% CI, 82%-96%). In meta-regression, among the various potential covariates, scanner manufacturer was associated with study heterogeneity. Conclusions and Relevance Magnetic resonance enterography, which is a noninvasive, radiation-free modality, demonstrates high diagnostic performance in the diagnosis of active inflammation in pediatric patients with IBD, especially at the per-patient level.
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Affiliation(s)
- Hee Mang Yoon
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Chong Hyun Suh
- Department of Radiology, Namwon Medical Center, Namwon-si, Republic of Korea
| | - Jeong Rye Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Jin Seong Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Ah Young Jung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Kyung Mo Kim
- Department of Pediatrics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Young Ah Cho
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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14
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Advanced imaging techniques in pediatric body MRI. Pediatr Radiol 2017; 47:522-533. [PMID: 28409251 DOI: 10.1007/s00247-017-3778-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/19/2016] [Accepted: 01/03/2017] [Indexed: 12/13/2022]
Abstract
While there are many challenges specific to pediatric abdomino-pelvic MRI, many recent advances are addressing these challenges. It is therefore essential for radiologists to be familiar with the latest advances in MR imaging. Laudable efforts have also recently been implemented in many centers to improve the overall experience of pediatric patients, including the use of dedicated radiology child life specialists, MRI video goggles, and improved MR suite environments. These efforts have allowed a larger number of children to be scanned while awake, with fewer studies being done under sedation or anesthesia; this has resulted in additional challenges from patient motion and difficulties with breath-holding and tolerating longer scan times. In this review, we highlight common challenges faced in imaging the pediatric abdomen and pelvis and discuss the application of the newest techniques to address these challenges. Additionally, we highlight the newest advances in quantified imaging techniques, specifically in MR liver iron quantification. The techniques described in this review are all commercially available and can be readily implemented.
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Specialized Imaging and Procedures in Pediatric Pancreatology: A North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Clinical Report. J Pediatr Gastroenterol Nutr 2017; 64:472-484. [PMID: 28230608 DOI: 10.1097/mpg.0000000000001371] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES An increasing number of children are being diagnosed with pancreatitis and other pancreatic abnormalities. Dissemination of the information regarding existing imaging techniques and endoscopic modalities to diagnose and manage pancreatic disorders in children is sorely needed. METHODS We conducted a review of the medical literature on the use of the following imaging and procedural modalities in pediatric pancreatology: transabdominal ultrasonography (TUS), computed tomography (CT), magnetic resonance imaging (MRI)/magnetic resonance cholangiopancreatography (MRCP), endoscopic ultrasonography (EUS), and endoscopic retrograde cholangiopancreatography (ERCP). Recommendations for current use and future research were identified. RESULTS TUS offers noninvasive images of the pancreas but has limitations to details of parenchyma and ductal structures. CT offers improved detail of pancreatic parenchyma, solid masses, and traumatic injuries, but requires relatively high levels of ionizing radiation and does not adequately assess ductal anatomy. MRI/MRCP offers detailed intrinsic tissue assessment and pancreatic ductal characterization, but requires longer image acquisition time and is relatively poor at imaging calcifications. EUS provides excellent evaluation of pancreatic parenchyma and ductal anatomy, but can be subjective and operator dependent and requires sedation or anesthesia. EUS offers the capacity to obtain tissue samples and drain fluid collections and ERCP offers the ability to improve drainage by performing sphincterotomy or placing pancreatic stents across duct injuries and strictures. CONCLUSIONS Various imaging modalities may be used in pediatric pancreatology, but TUS and MRI/MRCP are favored. Interventional therapeutic maneuvers primarily involve use of ERCP and EUS. Future research is necessary to optimize equipment, expertise, and appropriate indications.
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Ehman EC, Phelps AS, Ohliger MA, Rhee SJ, MacKenzie JD, Courtier JL. Detection of bowel inflammation with fused DWI/T2 images versus contrast-enhanced images in pediatric MR enterography with histopathologic correlation. Clin Imaging 2016; 40:1135-1139. [PMID: 27497037 DOI: 10.1016/j.clinimag.2016.07.006] [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: 04/30/2016] [Revised: 06/20/2016] [Accepted: 07/18/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the fused, colorized diffusion weighted imaging (DWI) and anatomic T2 images compared to routine contrast-enhanced T1 images at pediatric magnetic resonance enterography (MRE). METHODS Fused, colorized DWI/T2 images were created from patients with magnetic resonance enterography (MRE) and colonoscopy/biopsy. Radiologists noted inflammation in five bowel segments (terminal ileum-rectosigmoid colon) on postcontrast images and DWI/T2 images. Test characteristics and agreement were calculated. RESULTS For 20 patients, sensitivity/specificity/positive predictive value (PPV)/negative predictive value (NPV) were 0.53/0.90/0.77/0.76 for DWI/T2 and 0.45/0.90/0.72/0.73 for postcontrast images. Intraobserver agreement was ҡ=0.45-0.73. Interobserver agreement was ҡ=0.53 for DWI/T2 and ҡ=0.63 for postcontrast images. CONCLUSION DWI/T2 images are similar in sensitivity/specificity to contrast-enhanced images and with moderate intra/interobserver reliability.
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Affiliation(s)
- Eric C Ehman
- Department of Radiology and Biomedical Imaging, UCSF, 505 Parnassus Ave., San Francisco, CA 94143-0628.
| | - Andrew S Phelps
- Department of Radiology and Biomedical Imaging, UCSF Benioff Children's Hospital, 1975 4th Street, CL1578L, San Francisco, CA 94158.
| | - Michael A Ohliger
- Department of Radiology and Biomedical Imaging, UCSF, 505 Parnassus Ave., San Francisco, CA 94143-0628.
| | - Sue J Rhee
- Department of Pediatrics, Division of Ped. Gastroenterology, UCSF Benioff Children's Hospital, Box 0136, 550 16th Street, San Francisco, CA 94134.
| | - John D MacKenzie
- Department of Radiology and Biomedical Imaging, UCSF Benioff Children's Hospital, 1975 4th Street, CL1578L, San Francisco, CA 94158.
| | - Jesse L Courtier
- Department of Radiology and Biomedical Imaging, UCSF Benioff Children's Hospital, 1975 4th Street, CL1578L, San Francisco, CA 94158.
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Greer MLC. How we do it: MR enterography. Pediatr Radiol 2016; 46:818-28. [PMID: 27229500 DOI: 10.1007/s00247-016-3596-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 02/04/2016] [Accepted: 02/25/2016] [Indexed: 01/08/2023]
Abstract
Magnetic resonance enterography (MRE) now plays a central role in diagnosing pediatric inflammatory bowel disease (IBD), and its role in other intestinal pathologies such as scleroderma is gradually expanding. MRE helps distinguish between Crohn disease and ulcerative colitis, defining extent and severity. Standard MRE protocols can be optimized in children and adolescents to be diagnostic and well tolerated, both of which are important with increasing use of serial MRE in pediatric IBD for monitoring treatment response and evaluating complications. MRI is especially suited to this role given its lack of ionizing radiation. MRE compliance can be improved through patient education. Differing from adult MRE, pediatric MRE protocols use weight-based formulas to calculate oral and intravenous contrast media and antispasmodic agent doses, using either hyoscine-N-butylbromide or glucagon. Nausea is more commonly experienced with glucagon; however vomiting occurs in <10% of children with either agent. Standard and advanced sequences applied in adults are also used in children and adolescents. These include static and cinematic balanced steady-state free precession sequences, single-shot T2-weighted sequences, diffusion-weighted imaging and pre- and post-contrast 3-D T1-weighted gradient echo sequences. Magnetization transfer imaging and quantitative assessment of bowel to distinguish inflammation and fibrosis are not yet standard in pediatric MRE, but show promise.
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Affiliation(s)
- Mary-Louise C Greer
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, Ontario, M5G 1X8, Canada. .,Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
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Jaimes C, Gee MS. Strategies to minimize sedation in pediatric body magnetic resonance imaging. Pediatr Radiol 2016; 46:916-27. [PMID: 27229508 DOI: 10.1007/s00247-016-3613-z] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 01/11/2016] [Accepted: 02/05/2016] [Indexed: 12/13/2022]
Abstract
The high soft-tissue contrast of MRI and the absence of ionizing radiation make it a valuable tool for assessment of body pathology in children. Infants and young children are often unable to cooperate with awake MRI so sedation or general anesthesia might be required. However, given recent data on the costs and potential risks of anesthesia in young children, there is a need to try to decrease or avoid sedation in this population when possible. Child life specialists in radiology frequently use behavioral techniques and audiovisual support devices, and they practice with children and families using mock scanners to improve child compliance with MRI. Optimization of the MR scanner environment is also important to create a child-friendly space. If the child can remain inside the MRI scanner, a variety of emerging techniques can reduce the effect of involuntary motion. Using sequences with short acquisition times such as single-shot fast spin echo and volumetric gradient echo can decrease artifacts and improve image quality. Breath-holding, respiratory triggering and signal averaging all reduce respiratory motion. Emerging techniques such as radial and multislice k-space acquisition, navigator motion correction, as well as parallel imaging and compressed sensing reconstruction methods can further accelerate acquisition and decrease motion. Collaboration among radiologists, anesthesiologists, technologists, child life specialists and families is crucial for successful performance of MRI in young children.
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Affiliation(s)
- Camilo Jaimes
- Division of Pediatric Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Ellison 237, Boston, MA, 02114, USA.,Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Michael S Gee
- Division of Pediatric Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Ellison 237, Boston, MA, 02114, USA. .,Department of Radiology, Harvard Medical School, Boston, MA, USA.
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Magnetic Resonance Enterography Healing and Magnetic Resonance Enterography Remission Predicts Improved Outcome in Pediatric Crohn Disease. J Pediatr Gastroenterol Nutr 2016; 62:378-83. [PMID: 26348683 DOI: 10.1097/mpg.0000000000000976] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Mucosal healing predicts clinical remission and improved outcomes in patients with Crohn disease (CD). Magnetic resonance enterography (MRE) is a noninvasive imaging modality that can assess small and large bowel wall inflammation. Evidence suggests that MRE may be an acceptable alternative to evaluate mucosal healing over endoscopy. Our objective is to determine whether MRE remission predicts clinical remission at follow-up in children with CD. METHODS We performed an institutional review board-approved retrospecitve chart review using our prospectively maintained MRE CD database. Inclusion criteria were all children who underwent an MRE more than 6 months after diagnosis with CD who had follow-up of at least 1 year from imaging. RESULTS A total of 101 children with CD underwent MRE, a median of 1.3 years from diagnosis with a median follow-up of 2.8 years after MRE. Active inflammation was detected in 65 MRE studies, whereas 36 MRE studies demonstrated MRE remission. A total of 88.9% of children demonstrating MRE remission were in clinical remission at follow-up, whereas only 44.6% of those demonstrating MRE active inflammation achieved clinical remission. Children demonstrating MRE-active inflammation were more likely to have a change in medication (44.6% vs 8.3%) and more likely to undergo surgery (18.5% vs 2.8%). CONCLUSIONS MRE remission is associated with clinical remission at follow-up at least 1 year after MRE. MRE remission was associated with fewer medication changes and fewer surgeries suggesting that, similar to endoscopic remission, MRE remission demonstrates improved outcome. Additional research is needed to confirm that MRE can be used as a surrogate for mucosal healing.
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20
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Haas K, Rubesova E, Bass D. Role of imaging in the evaluation of inflammatory bowel disease: How much is too much? World J Radiol 2016; 8:124-131. [PMID: 26981221 PMCID: PMC4770174 DOI: 10.4329/wjr.v8.i2.124] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 11/24/2015] [Accepted: 01/07/2016] [Indexed: 02/06/2023] Open
Abstract
Inflammatory bowel disease (IBD) is a lifelong condition with waxing and waning disease course that requires reassessment of disease status as well as screening for complications throughout a patient’s lifetime. Laboratory testing, endoscopic assessment, and fecal biomarkers are often used in the initial diagnosis and ongoing monitoring of a patient with IBD. Imaging plays an integral role in the diagnosis and evaluation of IBD. Different imaging modalities can be used over the course of a patient’s lifetime, from the initial screening and diagnosis of IBD, to determining the extent of intestinal involvement, monitoring for disease activity, and evaluating for complications of uncontrolled IBD. The various imaging modalities available to the provider each have a unique set of risks and benefits when considering cost, radiation exposure, need for anesthesia, and image quality. In this article we review the imaging techniques available for the evaluation of IBD including fluoroscopic small bowel follow-through, computed tomography enterography, magnetic resonance enterography, and transabdominal ultrasound with particular focus on the judicious use of imaging and the risks and benefits of each option. We also review the risks of ionizing radiation, strategies to reduce exposure to ionizing radiation, and current imaging guidelines among pediatric and adult patient with IBD.
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Gunderman RB, Trevino MA. Understanding and Enhancing the Pediatric Radiology Patient's Experience. Acad Radiol 2016; 23:262-3. [PMID: 26481510 DOI: 10.1016/j.acra.2015.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 08/30/2015] [Accepted: 09/11/2015] [Indexed: 11/18/2022]
Affiliation(s)
- Richard B Gunderman
- Indiana University School of Medicine, 702 North Barnhill Drive, Room 1053, Indianapolis, IN 46202.
| | - Michael A Trevino
- Indiana University School of Medicine, 702 North Barnhill Drive, Room 1053, Indianapolis, IN 46202
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