Awake Magnetic Resonance Imaging Research Articles

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

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

The Efficacy of Virtual Reality Game Preparation for Children Scheduled for Magnetic Resonance Imaging Procedures (IMAGINE): Protocol for a Randomized Controlled Trial.

BackgroundIt is known that magnetic resonance imaging (MRI) procedures generate fear and anxiety. Children may become restless during scanning, which results in movement artifacts requiring the MRI procedure to be repeated with sedation. Few studies seem to have looked at the effect of immersive virtual reality (IVR) on anxiety in children scheduled for MRI scans and how to identify which children are more responsive.ObjectiveThe aims of this study are 3-fold: develop an algorithm of predictability based on biofeedback, address feasibility and acceptability of preprocedural IVR game preparation for anxiety management during MRI procedures, and examine the efficacy of IVR game preparation compared with usual care for the management of procedural anxiety during MRI scans.MethodsThis study will have 2 phases. We will first conduct a field test with 10 participants aged 7 to 17 years to develop a predictive algorithm for biofeedback solution and to address the feasibility and acceptability of the research. After the field test, a randomized controlled trial will be completed using a parallel design with 2 groups: an experimental group (preprocedural IVR game preparation) and a usual care group (standard care as per the radiology department’s protocol) in an equal ratio of 49 participants per group for 98 participants. Recruitment will be carried out at a hospital in Quebec, Canada. The experimental group will receive a preprocedural IVR game preparation (IMAGINE) that offers an immersive simulation of the MRI scan. Participants will complete a questionnaire to assess the acceptability, feasibility, and incidence of side effects related to the intervention and the biofeedback device. Data collected will include sociodemographic and clinical characteristics as well as measures of procedure-related anxiety with the French-Canadian version of the State-Trait Anxiety Inventory for Children (score 1-3) and the Children’s Fear Scale (score 0-4). Physiological signs will be noted and include heart rate, skin conductance, hand temperature, and muscle tension. Measures of the level of satisfaction of health care professionals, parents, and participants will also be collected. Analyses will be carried out according to the intention-to-treat principle, with a Cronbach α significance level of .05.ResultsAs of May 10, 2022, no participant was enrolled in the clinical trial. The data collection time frame is projected to be between April 1, 2022, and March 31, 2023. Findings will be disseminated through peer-reviewed publications.ConclusionsOur study provides an alternative method for anxiety management to better prepare patients for an awake MRI procedure. The biofeedback will help predict which children are more responsive to this type of intervention. This study will guide future medical practice by providing evidence-based knowledge on a nonpharmacological therapeutic modality for anxiety management in children scheduled for an MRI scan.Trial RegistrationClinicalTrials.gov NCT04988516; https://clinicaltrials.gov/ct2/show/NCT04988516International Registered Report Identifier (IRRID)PRR1-10.2196/30616

Male and Female C57BL/6 Mice Respond Differently to Awake Magnetic Resonance Imaging Habituation.

Traditionally, preclinical magnetic resonance imaging (MRI) has been performed in anesthetized animals. However, anesthesia has been shown to perturb normal brain function and physiology. Such effects limit our ability to detect subtle physiological alterations in disease models and treatment studies, thus hampering discovery and compromising generality of findings. Therefore, methods for awake animal MRI are needed to study the rodent brain in its natural physiological state, free of anesthetics. Current setups for awake animal MRI rely on restraining systems to avoid animal movement during scanning. To reduce restraint stress, animals are habituated to the scanner environment prior to MRI data collection. To date, however, most awake MRI studies employ male rodents only. This is a fundamental limitation as results obtained may be pertinent only to half of the population. We characterized training and habituation responses of male and female mice to provide improved, sex-dependent training procedures for awake mouse MRI. We recorded heart rate, monitored behavioral responses (body weight and fecal boli weight) and fecal corticosterone levels (FCM) as indicators of wellbeing and stress during a 14-day progressive habituation protocol. In addition, we also assessed discomfort levels and anxiety using the mouse grimace scale (MGS) and light/dark test (LDT), respectively. All scores were compared between both groups. We found that heart rate was significantly decreased after 10 and 11 days of training for both males and females, respectively. However, the specific time course for this decrease was significantly different between males and females, and females exhibited higher anxiety levels during habituation and 14 days after habituation than males. Lastly, we also found that mean FCM levels for both groups were decreased after 11 days of MRI habituation. The present work shows that mice can be successfully trained for extended MRI sessions which is necessary for many (particularly non-fMRI) studies. Importantly, we find that males and females differ in their response to awake MRI habituation, which should be considered in future awake MRI studies that aim to include male and female mice.

Play simulation for children in magnetic resonance imaging

IntroductionMagnetic Resonance Imaging (MRI) can be a challenging examination, particularly for children. The aim of this Clinical Perspective is to outline early experiences, based upon a service evaluation (defined as an assessment of how well the intended aims are achieved), of the Playful Magnetic Resonance Imaging Simulator (PMRIS) (Domed, Lyon, France) in reducing the number of children requiring general anaesthetic (GA) in order to undergo Magnetic Resonance Imaging (MRI). MethodsBaseline data from an audit of children undergoing MRI under GA in 2017 had previously been captured as part of the funding bid for the PMRIS. Estimation of costs associated with anaesthesia were made, then combined with the overall numbers of MRI under GA to estimate projected anaesthetic related cost-savings based on the reported effectiveness of the PMRIS. Once the PMRIS was in place, data were collected for children attending a Play Specialist supervised session. The number and age of children proceeding directly to MRI without requiring a GA was determined. The associated cost benefit was calculated and compared with the projections made in the initial funding bid. ResultsOver a 7 month period 36 children, average age 6 years, age range 4 to 11 years, who had initially been triaged for MRI under GA, attended a Play Specialist led session on the PMRIS. Of these, 30, average age 6 years, age range 4 to 11 years proceeded directly to MRI without a GA. Based on the costings used for the initial funding bid, this equates to a gross cost-saving of £9,000 over 7 months. DiscussionThis service evaluation shows a positive impact of Play Specialist sessions using the PMRIS with 30 out of 36 children having a successful awake MRI as a result. There are limitations to this evaluation, particularly that whilst all these children had been triaged for MRI under GA it cannot be known how many might have had an awake MRI with different preparation. Nevertheless, according to the local referral pathways these children would otherwise have had MRI under GA. ConclusionThis service evaluation has shown that the number of GAs required for children having MRI has reduced for this particular service through the use of the PMRIS, with Play Specialist support, with associated reduction in risk and cost savings.

0674 Association Between Lateral Wall Collapse On Drug-induced Sleep Endoscopy And MRI Findings In Hypoglossal Nerve Stimulator Patients

Abstract Introduction Hypoglossal nerve stimulator (HNS) is an effective and safe alternative therapy for obstructive sleep apnea (OSA) in selected patients. Emerging evidence demonstrates that the outcome of HNS is variable, especially for patients with lateral wall collapse on drug-induced sleep endoscopy (DISE). Awake magnetic resonance imaging (MRI) offers detailed visualization of soft tissue. The aim of this study was to determine whether lateral wall collapse on DISE is associated with awake MRI findings in prospective HNS patients. Methods Patients from the ADHERE Registry, an international outcomes study for UAS were used for this study. At baseline, awake, supine MRI scans of each subject’s head and neck region were collected. The distance between the lateral walls was measured at the level of the hard palate, located by the appearance of the posterior nasal spine, using axial T2 turbo spin echo MRI. DISE assessments of the upper airway were recorded using the VOTE classification. All statistical analyses were performed using SPSS IBM 19.0 software program. Kendall’s Tau-b was performed to compare the association between VOTE scoring and MRI findings. Results Twenty-seven patients (N = 3 female, AHI = 28.8±10.5, BMI = 28.8 ±3.8 kg/m2, age = 53±9.9 years) were included in this study. The mean overall VOTE score and lateral wall score was 5.6±1.1 and 0.5±0.5, respectively. The mean lateral wall distance was 18.8±3.2 mm. A significant, inverse association was found between MRI lateral wall measurement and oropharyngeal lateral wall scoring on DISE (T=-.332,p=0.042) but not other anatomic subsites on DISE. Conclusion In our study, greater lateral wall collapse on DISE corresponded to narrower lateral airway distance on MRI. The utility of static imaging modalities such as MRI as patient selection tools for HNS warrants further study. Support Drs. Dedhia and Schwab receive related support for this project from the National Institutes of Health (NHBLI R01HL144859)