Pediatric Magnetic Resonance Imaging Research Articles

Compressed SENSE in Pediatric Brain Tumor MR Imaging

PurposeTo compare the image quality, examination time, and total energy release of a standardized pediatric brain tumor magnetic resonance imaging (MRI) protocol performed with and without compressed sensitivity encoding (C-SENSE). Recently introduced as an acceleration technique in MRI, we hypothesized that C‑SENSE would improve image quality, reduce the examination time and radiofrequency-induced energy release compared with conventional examination in a pediatric brain tumor protocol.MethodsThis retrospective study included 22 patients aged 2.33–18.83 years with different brain tumor types who had previously undergone conventional MRI examination and underwent follow-up C‑SENSE examination. Both examinations were conducted with a 3.0-Tesla device and included pre-contrast and post-contrast T1-weighted turbo-field-echo, T2-weighted turbo-spin-echo, and fluid-attenuated inversion recovery sequences. Image quality was assessed in four anatomical regions of interest (tumor area, cerebral cortex, basal ganglia, and posterior fossa) using a 5-point scale. Reader preference between the standard and C‑SENSE images was evaluated. The total examination duration and energy deposit were compared based on scanner log file analysis.ResultsRelative to standard examinations, C‑SENSE examinations were characterized by shorter total examination times (26.1 ± 3.93 vs. 22.18 ± 2.31 min; P = 0.001), reduced total energy deposit (206.0 ± 19.7 vs. 92.3 ± 18.2 J/kg; P < 0.001), and higher image quality (overall P < 0.001).ConclusionC‑SENSE contributes to the improvement of image quality, reduction of scan times and radiofrequency-induced energy release relative to the standard protocol in pediatric brain tumor MRI.

Segmentation of the Aorta and Pulmonary Arteries Based on 4D Flow MRI in the Pediatric Setting Using Fully Automated Multi-Site, Multi-Vendor, and Multi-Label Dense U-Net.

Automated segmentation using convolutional neural networks (CNNs) have been developed using four-dimensional (4D) flow magnetic resonance imaging (MRI). To broaden usability for congenital heart disease (CHD), training with multi-institution data is necessary. However, the performance impact of heterogeneous multi-site and multi-vendor data on CNNs is unclear. To investigate multi-site CNN segmentation of 4D flow MRI for pediatric blood flow measurement. Retrospective. A total of 174 subjects across two sites (female: 46%; N=38 healthy controls, N=136 CHD patients). Participants from site 1 (N=100), site 2 (N=74), and both sites (N=174) were divided into subgroups to conduct 10-fold cross validation (10% for testing, 90% for training). 3 T/1.5T; retrospectively gated gradient recalled echo-based 4D flow MRI. Accuracy of the 3D CNN segmentations trained on data from single site (single-site CNNs) and data across both sites (multi-site CNN) were evaluated by geometrical similarity (Dice score, human segmentation as ground truth) and net flow quantification at the ascending aorta (Qs), main pulmonary artery (Qp), and their balance (Qp/Qs), between human observers, single-site and multi-site CNNs. Kruskal-Wallis test, Wilcoxon rank-sum test, and Bland-Altman analysis. A P-value <0.05 was considered statistically significant. No difference existed between single-site and multi-site CNNs for geometrical similarity in the aorta by Dice score (site 1: 0.916 vs. 0.915, P=0.55; site 2: 0.906 vs. 0.904, P=0.69) and for the pulmonary arteries (site 1: 0.894 vs. 0.895, P=0.64; site 2: 0.870 vs. 0.869, P=0.96). Qs site-1 medians were 51.0-51.3mL/cycle (P=0.81) and site-2 medians were 66.7-69.4mL/cycle (P=0.84). Qp site-1 medians were 46.8-48.0 mL/cycle (P=0.97) and site-2 medians were 76.0-77.4mL/cycle (P=0.98). Qp/Qs site-1 medians were 0.87-0.88 (P=0.97) and site-2 medians were 1.01-1.03 (P=0.43). Bland-Altman analysis for flow quantification found equivalent performance. Multi-site CNN-based segmentation and blood flow measurement are feasible for pediatric 4D flow MRI and maintain performance of single-site CNNs. 3 TECHNICAL EFFICACY: Stage 2.

Comparing a Virtual Reality-Based Simulation App (VR-MRI) With a Standard Preparatory Manual and Child Life Program for Improving Success and Reducing Anxiety During Pediatric Medical Imaging: Randomized Clinical Trial.

BackgroundThe experience of undergoing magnetic resonance imaging (MRI) can be anxiety provoking, particularly for pediatric patients and their families. Alternative methods to improve success and experiences without the use of sedation are needed.ObjectiveThis study aims to compare the effectiveness of a virtual reality (VR)—based simulation app (VR-MRI) with a standard preparatory manual (SPM) and a hospital-based Child Life Program (CLP) on success and anxiety during a simulated pediatric MRI scan. Our secondary aim is to compare caregivers’ reported anxiety, procedural data, caregiver usability, child satisfaction, and fun.MethodsThis unblinded, randomized, triple-arm clinical trial involved 92 children aged 4-13 years and their caregivers. Recruitment was conducted through posters, public libraries, community centers, and social media. At a 2-hour session, participants were instructed to prepare for a simulated MRI head scan using one of three randomly assigned preparation materials: the VR-MRI app, SPM, or the CLP. Data were collected before preparation, during a simulated MRI head scan, and after the simulated scan. The primary outcomes were the success of the simulated MRI scan (MoTrak head motion tracking system), and child-reported anxiety (Venham picture test). We secondarily measured caregivers’ reported anxiety (short State-Trait Anxiety Inventory), procedural data (minutes), usability (Usefulness, Satisfaction, and Ease of Use Questionnaire), and child-reported satisfaction and fun (visual analog scales).ResultsA total of 84 participants were included in the final analysis (VR-MRI: 30/84, 36%; SPM: 24/84, 29%; and CLP: 30/84, 36%). There were no clinically significant differences between the groups in terms of success during the MRI simulation (P=.27) or the children’s reported anxiety at any timepoint (timepoint 1, P=.99; timepoint 2, P=.008; timepoint 3, P=.10). Caregivers reported being significantly more anxious after preparing with the manual than caregivers in the other 2 groups (P<.001). Child and caregiver anxiety had a significant relationship, increasing together with moderate effect (r84=0.421; P<.001). Participants using VR-MRI took the most time to prepare (P<.001) and participants using the manual took the least time (P<.001). No statistically significant relationships were found between time preparing and time completing the simulated assessment (P=.13). There were no differences found in ease of use (P=.99), ease of learning (P=.48), and usefulness (P=.11) between the groups; however, caregivers reported being significantly more satisfied with the VR-MRI app and CLP than SPM (P<.001). Children reported the most satisfaction with the CLP (P<.001). There were no differences in how much fun the preparation materials were perceived to be (P=.37).ConclusionsDigital preparation experiences using VR-based media could be a viable solution to improve the success of nonsedated MRI scans, with outcomes comparable with hospital-based in-person preparatory programs. Future research should focus on validating the results in a real MRI setting.Trial RegistrationClinicaltrials.gov NCT03931382; https://clinicaltrials.gov/ct2/show/NCT03931382

Accessible pediatric neuroimaging using a low field strength MRI scanner

Magnetic resonance imaging (MRI) has played an increasingly relevant role in understanding infant, child, and adolescent neurodevelopment, providing new insight into developmental patterns in neurotypical development, as well as those associated with potential psychopathology, learning disorders, and other neurological conditions. In addition, studies have shown the impact of a child's physical and psychosocial environment on developing brain structure and function. A rate-limiting complication in these studies, however, is the high cost and infrastructural requirements of modern MRI systems. High costs mean many neuroimaging studies typically include fewer than 100 individuals and are performed predominately in high resource hospitals and university settings within high income countries (HICs). As a result, our knowledge of brain development, particularly in children who live in lower and middle income countries (LMICs) is relatively limited. Low field systems, with magnetic fields less than 100mT offer the promise of lower scanning costs and wide-spread global adoption, but routine low field pediatric neuroimaging has yet to be demonstrated. Here we present the first pediatric MRI data collected on a low cost and assessable 64mT scanner in children 6 weeks to 16 years of age and replicate brain volumes estimates and developmental trajectories derived from 3T MRI data. While preliminary, these results illustrate the potential of low field imaging as a viable complement to more conventional high field imaging systems, and one that may further enhance our knowledge of neurodevelopment in LMICs where malnutrition, psychosocial adversities, and other environmental exposures may profoundly affect brain maturation.

Magnetic resonance imaging brain sequences in pediatrics

There are various pediatric magnetic resonance imaging (MRI) protocols followed in institutes and by individual radiologists, determined by the disease process and the indication for imaging, to narrow down the differential diagnosis. Most times, it is beneficial to modify protocols when the scans are being done, based on the findings seen on initially acquired sequences. This is particularly useful in pediatric patients considering most of them are scanned either under sedation or general anesthesia, and repeat scans will be cumbersome. In this particular review article, we are going to discuss appropriate MRI sequences in scanning pediatric brains and the need for rapid MRI sequences. This is of immense importance as MRI in pediatric patients poses challenges both to radiologists and technologists. Consequently, appropriate MRI protocols should be set to avoid repeat studies.

Nonpharmacological interventions to reduce sedation/general anaesthesia in paediatric patients undergoing magnetic resonance imaging: A systematic review and meta-analysis protocol.

Magnetic resonance imaging is frequently used in paediatrics and requires the child/adolescent to remain still for 45min or more. The long and narrow scanner gantry makes loud noises and may cause anxiety. To complete the procedure, children and adolescents are often sedated or receive general anaesthesia. Our primary aim is to determine whether nonpharmacological interventions designed to mentally prepare, support or distract children, and adolescents are effective in reducing the need for sedation and general anaesthesia. We will conduct a systematic review with meta-analysis by searching the following electronic databases: Ovid MEDLINE, CINAHL, Embase and CENTRAL, as well as databases for ongoing trials. Eligibility criteria are based on the participants, intervention, comparator and outcome (PICO) framework. We will include intervention studies with comparator group(s) with no restriction on date. Two reviewers will independently screen titles/abstracts, and three reviewers will assess the full texts of potentially relevant studies. Data will be extracted, and the methodological quality will be assessed using Cochrane risk of bias tools. If the data allow, we will perform a meta-analysis using a random effects model on the primary outcome, sedation/general anaesthesia. A narrative synthesis will supplement the statistical analysis. Quality of evidence for the primary outcome will be assessed using the grading of recommendations, assessment, development and evaluations (GRADE) approach. Our findings will provide directions for future research and may guide clinicians in terms of which type(s) of intervention(s) to implement to reduce the use of sedation/general anaesthesia during paediatric magnetic resonance imaging.

Simultaneous Head and Spine MR Imaging in Children Using a Dedicated Multichannel Receiver System at 3T

The purpose of this work was to enable simultaneous head and spine Magnetic Resonance imaging (MRI) in children at 3T by using a dedicated multichannel radiofrequency coil array system. A 24-channel head and spine pediatric coil system was developed and constructed. The coils performance was compared with a commercially available 24-channel adult head-neck coil and a spine coil (1-4 spine of 16-channel were selected). Signal-to-noise ratio (SNR) and parallel imaging capability were quantitatively evaluated by phantom studies and in vivo imaging experiments. With Institutional Review Board and Ethics Committee approval, the designed coil was used to acquire head and spine images on 27 children in clinical settings. The pediatric coil provided substantial SNR improvements with an increase of 32 % to 40 % in the brain region and up to a two-fold increase in the surface. SNR increased by at least 18 % in the spine region. The coil enabled higher resolution and a faster imaging speed, owing to significantly improved SNR. Extensive coverage of the coil enabled high-quality fast imaging from head-neck to the whole spine. Good image quality with an average score 4.63 out of 5 was achieved using the developed pediatric coil in clinical studies. Simultaneous head and spine MRI with superior performance have been successfully acquired in children subjects at 3T using the dedicated 24-channel head and spine pediatric coil system. The 24-channel pediatric coil system potentially can enhance pediatric head and spine MRI in clinical research and diagnosis.

Pediatric versus adult magnetic resonance imaging patterns in acute high ankle sprains.

There is a paucity of literature describing MRI patterns of high ankle sprains in pediatric patients. Radiologists should understand MRI patterns of these injuries in both adults and children. To describe normal MRI appearance of pediatric syndesmotic ligaments and compare MRI patterns of high ankle sprains in children versus adults. We reviewed consecutive ankle MRIs performed over 3years and divided them into three cohorts: a normal pediatric (≤16years) cohort, and pediatric and adult cohorts with acute/subacute ankle syndesmosis injuries. Our retrospective review assessed interobserver agreement (Cohen kappa coefficient) and normal pediatric syndesmotic anatomy. We compared patterns of high ankle sprains (Fisher exact test) including ligament tears, periosteal stripping, avulsions and fractures. Of the 582 ankle MRIs, we included 25 in the normal pediatric cohort, 20 in the pediatric injury cohort and 23 in the adult injury cohort. The anterior and posterior tibiofibular ligaments all attached to cortex or cartilaginous precursor, while the interosseous ligament/membrane complex attached to the fibrous periosteum in 22/25 (88%) normal pediatric cases. Tibial periosteal stripping at the interosseous ligament/membrane complex attachment occurred in 7/20 (35%) pediatric and 1/23 (4%) adult injury cases (P=0.02). No other statistically significant differences were found. Interobserver agreement ranged from kappa=0.46 to kappa=0.82 (ligament tears), 0.38 to 0.45 (avulsions) and 0.69 to 0.77 (periosteal stripping). The normal interosseous ligament/membrane complex typically attaches to fibrous periosteum rather than bony cortex. Tibial periosteal stripping, usually without tibial fracture, is significantly more common among pediatric high ankle sprains. MRI patterns of high ankle sprains are otherwise not significantly different between children and adults.

Magnetic Resonance Imaging as the Primary Imaging Modality in Children Presenting with Inflammatory Nontraumatic Atlantoaxial Rotatory Subluxation.

Inflammatory nontraumatic atlantoaxial rotatory subluxation (AAS) in children is an often-missed diagnosis, especially in the early stages of disease. Abscess formation and spinal cord compression are serious risks that call for immediate surgical attention. Neither radiographs nor non-enhanced computed tomography (CT) images sufficiently indicate inflammatory processes. Magnetic resonance imaging (MRI) allows a thorough evaluation of paraspinal soft tissues, joints, and ligaments. In addition, it can show evidence of vertebral distraction and spinal cord compression. After conducting a scoping review of the literature, along with scientific and practical considerations, we outlined a standardized pediatric MRI protocol for suspected inflammatory nontraumatic AAS. We recommend contrast-enhanced MRI as the primary diagnostic imaging modality in children with signs of torticollis in combination with nasopharyngeal inflammatory or ear nose and throat (ENT) surgical history.

Strategies to optimize a pediatric magnetic resonance imaging service.

A pediatric MRI service is a vital component of a successful radiology department. Building an efficient and effective pediatric MRI service is a multifaceted process that requires detailed planning for considerations related to finance, operations, quality and safety, and process improvement. These are compounded by the unique challenges of caring for pediatric patients, particularly in the setting of the recent coronavirus disease 2019 (COVID-19) pandemic. In addition to material resources, a successful pediatric MRI service depends on a collaborative team consisting of radiologists, physicists, technologists, nurses and vendor specialists, among others, to identify and resolve challenges and to strive for continued improvement. This article provides an overview of the factors involved in both starting and optimizing a pediatric MRI service, including commonly encountered obstacles and some proposed solutions to address them.

Signal intensity patterns in health and disease: basics of abdominal magnetic resonance imaging in children.

Magnetic resonance imaging (MRI) is playing an increasing role in pediatric abdominal imaging, especially in the evaluation of diffuse parenchymal disease where other imaging modalities might be less sensitive. While quantitative imaging is slowly being incorporated into clinical imaging, qualitative assessment of visceral signal intensity should be part of the routine clinical workflow of all radiologists. Based on their T1 and T2 weighting, the liver, spleen, kidneys and pancreas have characteristic signal intensity patterns with respect to one another and to skeletal muscle. It is important to recognize normal signal intensity patterns of viscera and their evolution with patient age to be able to identify age-related variations and accurately identify diffuse parenchymal disease. Knowledge of normal signal intensity patterns can also help identify ectopic locations of normal tissue such as splenic rests and splenosis. In this review, we discuss normal signal intensity patterns of upper abdominal viscera and their variations on commonly used sequences in pediatric abdominal MRI. We also review normal variations in the perinatal period. Knowledge of these patterns can help pediatric radiologists become more astute in their interpretation of diffuse parenchymal disease in the abdomen.

Accessible Pediatric Neuroimaging Using a Low Field Strength Portable MRI Scanner

Within the research context, pediatric magnetic resonance imaging (MRI) has added considerably to our knowledge and understanding of developing brain organization, architectural topology, and functional specialization. Clinically, MRI has aided the identification of injury and early disease, including leukodystrophies, hydrocephalus, stroke, hemorrhage, and encephalopathy amongst numerous others. However, the infrastructural needs of current state-of-the-art MR systems, including scanner cost, space and device shielding, power requirements, and clinical expertise, have limited pediatric MRI to specialized research centers and clinical settings in predominately higher income and resource settings. Here we present the first pediatric MRI data collected with a low cost, portable, and accessible 64mT field-strength scanner, replicating developmental trajectories derived from higher magnetic field data. Results demonstrate the potential of low field MR systems for routine pediatric neuroimaging, particularly in lower-income settings where higher field strength systems are ill-suited and uncommon, but of great need. Funding Information: Environmental Influences on Child Health Outcomes (ECHO) National Institutes of Health (SCD UG3OD023313), National Institutes of Health (SCD R34-DA050284), Bill and Melinda Gates Foundation (MMKB INV-005774). Declaration of Interests: The authors report no significant financial conflicts of interest with respect to the subject matter of this manuscript. Ethics Approval Statement: All data were acquired in accordance with ethical approval and oversight Lifespan Rhode Island Hospital institutional review board, with informed consent obtained from all parents or legal guardians.

Pediatric magnetic resonance imaging training versus job-readiness: using education research tools to re-align.

Fellows begin MRI training with variable experience and expertise. To better serve patients, pediatric radiology fellows should gain competence in MRI that enables seamless transition to independent practice. We implemented a needs assessment survey and conducted a focus group discussion to identify knowledge gaps and inform creation of a curriculum for pediatric body MRI. We electronically distributed a comprehensive anonymous needs assessment survey in October 2016 to current fellows and recent (<5years) graduates from Accreditation Council for Graduate Medical Education (ACGME)-accredited pediatric radiology fellowships, with follow-up in January 2017. We conducted a focus group discussion among current fellows at our institution in October 2017 to inform a better understanding of the results. Eighty-one pediatric radiologists (8 fellows/73 attendings) completed the survey (24%); 5 current fellows participated in the focus group. The technical issues most commonly identified with limited or no instruction during training included setting up an MR service, accessory equipment (coil) selection and MRI field inhomogeneity correction. Areas needing increased attention and inclusion within the curriculum included coil choice/patient positioning (n=42, 52%), contrast agents (n=40, 49%), field strength (n=33, 41%) and strategies for motion correction (n=33, 41%). Most fellows were uncomfortable with setting up an MR service (n=57, 70%), correcting field inhomogeneity (n=56, 69%) and improving image quality (n=50, 62%). The focus group showed consensus that there was insufficient MR training in residency to prepare them for fellowship. The group also preferred shorter lectures and streaming via video education/tutorials. While traditional instruction emphasizes image interpretation, trainees in pediatric radiology need a curriculum that also emphasizes technical and non-interpretive aspects of MRI.

Magnetic resonance imaging of the pediatric mediastinum: updates, tips and tricks.

Magnetic resonance imaging (MRI) of the pediatric mediastinum is challenging for the practicing radiologist. Many confounding factors add to the complexity of pediatric mediastinal MRI including small patient size, broad spectrum of mediastinal pathologies, motion artifacts and the need for sedation in a significant portion of children. However, with special attention to motion-reduction techniques and knowledge of pediatric-specific considerations, pediatric radiologists can help to provide accurate and timely diagnosis and also prevent multimodality imaging where MRI might be all that is needed. The purpose of this paper was present a practical review of pediatric mediastinal MRI with particular emphasis on diseases where MRI is the primary imaging modality of choice. Additionally, the author addresses those mediastinal processes for which MRI serves as a secondary problem-solving imaging tool.

Performance of overnight on-call radiology residents in interpreting unenhanced abdominopelvic magnetic resonance imaging studies performed for pediatric right lower quadrant abdominal pain

BackgroundAbdominopelvic magnetic resonance imaging (MRI) is increasingly being used to evaluate children with abdominal pain suspected of having acute appendicitis. At our institution, these examinations are preliminarily interpreted by radiology residents, especially when performed after hours.ObjectiveTo determine the accuracy of preliminary reports rendered by radiology residents in this setting.Materials and methodsThree hundred seventy-seven pediatric abdominopelvic MRI examinations were included. The preliminary (resident) and final (attending) radiology reports were coded as diagnosing acute appendicitis or no acute appendicitis. The concordance between resident and attending radiologist interpretations was calculated. Additionally, both resident and attending reports were compared to available surgical pathology or clinical follow-up data.ResultsOverall concordance rate for the diagnosis of acute appendicitis was 97.1%. Concordance for verified cases of acute appendicitis was 93.4%. Concordance rates did not differ by residents’ postgraduate year levels. When compared against surgical pathology or clinical follow-up data, residents demonstrated 91.2% sensitivity and 97.6% specificity. There was no statistically significant difference in the sensitivity or specificity of resident or attending radiologist interpretations.ConclusionRadiology residents demonstrate high concordance with attending pediatric radiologists in their interpretations of pediatric abdominopelvic MRI for acute appendicitis. The diagnostic performances of residents and attendings were comparable.

Pediatric Bassett's ligament: pathology or normal anatomy?

Bassett's ligament is an accessory fascicle of the anterior inferior tibiofibular ligament. The prevalence, normal thickness and clinical implications of a thickened ligament have not been described in the pediatric radiology literature. The purpose of this study was to determine the prevalence and thickness of Bassett's ligament in pediatric patients with magnetic resonance imaging (MRI) findings of lateral talar osteochondral lesions, medial talar osteochondral lesions and posterior ankle impingement, to compare these measurements with normal MRIs, and to compare the reproducibility of these measurements. This is a retrospective study of pediatric ankle MRIs with four cohorts containing 21 patients each. All MRIs were retrospectively reviewed by a pediatric musculoskeletal radiologist and a pediatric radiology fellow. The prevalence of Bassett's ligament and its axial thickness were obtained for each cohort with repeat measurements for intra-observer and interobserver variability. Average thickness and standard deviation of Bassett's ligament were calculated. The prevalence of Bassett's ligament and its thickness in each cohort were (mean±standard deviation): lateral osteochondral lesions, 71% (15/21), 1.9±0.5mm; medial osteochondral lesions, 52% (11/21), 1.4±0.2mm; posterior impingement, 52% (11/21), 1.3±0.2mm; and normal ankle examinations, 71% (15/21), 1.5±0.4mm. The thickness of Bassett's ligament was increased in the lateral talar osteochondral lesion group when compared to normal (P=0.02), while thickness in the medial osteochondral lesion and posterior impingement groups was not significant when compared to normal. The repeat measurements showed no significant difference in intra-observer and interobserver variability. Bassett's ligament is a normal structure in children. Thickening of Bassett's ligament is seen with lateral osteochondral lesions and may be an indirect sign of anterolateral tibiotalar capsule injury.

Trochlear Morphology Development: Study of Normal Pediatric Knee MRIs.

Trochlear dysplasia is a known risk factor for patellar dislocations yet normal trochlea development is not well described. This study will define the articular cartilage (AC) and subchondral trochlear morphology development in pediatric patients using magnetic resonance imaging (MRI) evaluation. A retrospective knee MRI review included patients aged 3 to 16 years with nonpatellofemoral-related diagnoses. International classification of diseases-9/International classification of diseases-10 codes were used to identify eligible study patients. Measurements of the trochlea were made on the basis of previously established methods using the axial MRI just distal to the physis at the deepest portion of the trochlear groove. Three linear [lateral trochlear height (LTH), medial trochlear height (MTH), and central trochlear height (CTH)] and 3 angular [sulcus angle (SA), lateral trochlear slope (LTS), and medial trochlear slope (MTS)] were made at AC and subchondral bone (SCB). The 12 measurements were made independently by 2 study authors. Inter-rater reliability was assessed using an interclass correlation coefficient for absolute agreement to the average of the scores. Trochlea measurements were summarized across age quartiles defined as first quartile (age, 5.1 to 8.3 y), second quartile (8.3 to 11.5 y), third quartile (11.5 to 14.3 y), fourth quartile (14.3to 16.9 y). Associations between age and trochlea measures were assessed using linear regression with Huber-White-adjusted SEs to account for clustering from a small number of patients (N=16) with >1 MRI. In total, 246 knee MRIs from 230 patients were included in this study; 113 patients (51%) were female, whereas 117 (49%) were male. A total of 116 MRIs (47%) were of the left knee and 130 (53%) were right knee. The average patient age was 11.4±3.4 years. Inter-rater agreement was high across all measures with interclass correlation coefficient values >0.7. Mean values for measurements are presented by age quartiles. LTH, MTH, and CTH showed a linear increase with age (range, 2 to 2.6 cm/y; P<0.001). SA, LTS, MTS measured at AC showed no change with age (P>0.05); however, LTS and MTS measured at SCB showed significant increases with age (0.6 and 0.9 degrees/y; P<0.001), whereas SA showed a decrease with age (-1.4 degrees/y; P<0.001). There were no significant differences found in the age associations by laterality, left versus right. There were no sex differences in the age associations for SA, LTS (P>0.05); however, for MTH, LTH, and CTH, males were found to have a significantly greater growth rate (P<0.001). This study found an increase in AC and SCB MTH, LTH, and CTH over time, as well as an increase in SCB LTS and MTS, with a decrease in SA. However, AC of the LTS and SA remained constant, with no significant change throughout growth. This normative data indicate that the LTS and SA of AC are predictors of final trochlea shape in normal development. Final trochlear morphologic development is nearly complete around age 12 years, with no significant changes occurring thereafter.

Pediatric MRI Without Anesthesia: The Effect of Application-Supported Communication to Prepare the Child

The purpose of this study was to assess whether using an educational video application to prepare children undergoing Magnetic Resonance Imaging (MRI) decrease the number of MRI scans in general anesthesia (GA) in children aged four to nine years, and to evaluate parents’ perceptions of children’s confidence using an educational video application to educate about the scan.During a 3-month period, 52 children aged four to nine were included in this study after the parents had given consent. Eleven of these children were scheduled for an MRI scan with GA. Each child received thirty minutes of preparation before their MRI scan. The radiographer used an educational video application called “HC And” with animated characters demonstrating the MRI scan procedure. After the scan, the parents answered a questionnaire to assess whether they thought the educational video application helped their child in being calm and able to cooperate during the MRI scan. All parents who participated in the study completed the questionnaire.All children, including the eleven children originally scheduled for GA, completed the MRI scan without GA. The parents rated the video application either overall good or very good, and felt that their child was better educated about the upcoming scan using the app. Also, parent responses indicated that their child was more confident before and during the scan using the educational video application. The percentage of MRI scans in GA in 2015 was 42% versus 24% in 2017 (p = .02).The results suggest that the number of children that are able to complete an MRI scan without GA is increased when preparation using video application supported communication is implemented in the daily routine. Furthermore, the children’s confidence as mediated by parents’ perception may increase by the use of the custom-designed educational video application.

TO EVALUATE SAFETY AND EFFECTIVENESS OF KETAMINE-PROPOFOL COMBINATION AND PROPOFOL ALONE IN DIAGNOSTIC RADIOLOGICAL PROCEDURES (MRI) IN PEDIATRIC PATIENTS.

Introduction: There is a growing need for magnetic resonance imaging (MRI) in children for accurate diagnosis and appropriate medical treatment. In recent times, small doses of ketamine have been used along with propofol for pediatric MRI sedation. Aims and objectives: to evaluate safety and effectiveness of Ketamine-propofol combination and propofol alone in diagnostic radiological procedures (MRI) in pediatric patients. Materials and methods: The present prospective randomized double blinded study was undertaken at Government General Hospital, Tirupati. Pediatric patients aged between 2 to 12 years of both sex, belonging to ASA grade I &amp; II and posted for elective MRI Brain scan were included in the study. Results: KP group had significantly more reactions than P group. Recovery time (time taken to achieve modified aldrete recovery score of 9-10) was 37.33±2.88 min and 19.6±2.67 min in Ketofol group and propofol group respectively. Conclusion: Ketofol is an attractive combination for procedural sedation.

Participant-driven Simulation Protocol With a Mock Scanner for Pediatric Magnetic Resonance Neuroimaging Preparation Without Sedation

BackgroundSimulation using a mock scanner preparation is beneficial for pediatric patients undergoing magnetic resonance imaging (MRI) without sedation for the assessment of neurocognitive function. However, using a simulation protocol for improving the completion of pediatric MRI has not been studied extensively. MethodsA simulation protocol using a mock scanner “Zero-Tesla” preparation immediately before 3T MRI was utilized based on participants’ demographics. The success rate of each protocol step was compared between children with typical development (TD) and those with neurodevelopmental disorders (NDDs). ResultsTwo-hundred forty-one children (4-17 years; 152 males, 89 females; 42.3% TD and 57.7% NDDs) were included. Acceptable MRI qualities were obtained for 100 (98.0%) and 130 (93.5%) children in the TD and NDD groups, respectively. In the NDD group, Zero-T application rates were higher in the young childhood (TD vs NDD; 2% vs 56%, p < .001), middle childhood (5% vs 38%, p < .01), and adolescence (0% vs 49%, p < .001) subgroups than those in the TD group. ConclusionsUse of a simulation protocol could contribute to the successful completion of advanced MRI without sedation in children with TD and NDDs.