Resonance Imaging In Pediatric Patients Research Articles

Anesthesia practices during magnetic resonance imaging in pediatric patients

Aims: The use of magnetic resonance imaging (MRI) is becoming increasingly common for diagnostic and therapeutic purposes in pediatric cases. Among children who are too young to cooperate with the procedure or in those with anxiety, anesthesia may be required to minimize excessive motion and optimize image quality. The aim of this study was to determine the efficacy and associated complications of different anesthesia techniques used during MRI in pediatric patients at our hospital. Methods: Anesthesia follow-up forms and computer records of pediatric patients who had undergone MRI under anesthesia between January 2021 and January 2023 in a training and research hospital in Ankara were retrospectively reviewed. The included patients were categorized into four groups according to their anesthesia maintenance protocols to compare their efficacy and associated complications. Results: Of the 358 included patients, only 2% underwent MRI under general anesthesia with a laryngeal mask airway (LMA), whereas the rest underwent MRI under sedation. In our hospital, the most commonly used technique for MRI under anesthesia in pediatric patients involved sevoflurane inhalation with a simple facemask and airway (54.5%), and the lowest complication rate (0.8%) was observed in those who underwent only anesthesia induction without the administration of an agent for the maintenance of anesthesia. Conclusion: Daily anesthesia is generally considered the most effective and comfortable method for sedation during MRI. The results of this study suggest that anesthesia involving sevoflurane inhalation with a simple face mask applied to preserve spontaneous breathing is an effective and safe method for pediatric patients undergoing MRI.

Coronary Events Following Dobutamine Stress Cardiac Magnetic Resonance Imaging in Pediatric Patients.

Dobutamine stress cardiac magnetic resonance (dsCMR) has demonstrated value in identifying patients at risk for adverse cardiovascular events in adults with coronary artery disease, but its prognostic value in younger patients is unknown. This study sought to evaluate the relationship between dsCMR results and the risk of subsequent cardiovascular events in children. Patients age < 23years who underwent dsCMR at Boston Children's Hospital were eligible for inclusion. Patients were excluded if no follow-up data were available after dsCMR or the dsCMR protocol was not completed. Data regarding the presence of inducible regional wall motion abnormalities and subsequent cardiovascular events during follow-up were analyzed. Cardiovascular events included myocardial infarction, surgical or catheter-based coronary artery intervention, and ischemic symptoms. Among 80 dsCMR studies in 64 patients with median age 5.3years (range 0.5-22.4years), 3 patients had a positive dsCMR with inducible regional wall motion abnormalities. Over a median follow-up of 7.4years (IQR 4.0-11.2), 2 of these patients underwent surgical intervention (coronary artery bypass grafting and unroofing of a myocardial bridge) and the third remained asymptomatic with no interventions. Among 61 patients with a negative dsCMR, none experienced myocardial infarction, death, or aborted sudden death. Four underwent cardiac interventions (cardiac transplantation, coronary artery bypass grafting, and unroofing) due to symptoms or catheterization findings. In pediatric patients undergoing dsCMR, wall motion abnormalities indicating inducible ischemia were uncommon. Those with a negative dsCMR were unlikely to experience an adverse cardiac event or undergo a cardiac intervention on medium-term follow-up.

Three-dimensional ultrashort echo time magnetic resonance imaging in pediatric patients with pneumonia: a comparative study

BackgroundUTE has been used to depict lung parenchyma. However, the insufficient discussion of its performance in pediatric pneumonia compared with conventional sequences is a gap in the existing literature. The objective of this study was to compare the diagnostic value of 3D-UTE with that of 3D T1-GRE and T2-FSE sequences in young children diagnosed with pneumonia.MethodsSeventy-seven eligible pediatric patients diagnosed with pneumonia at our hospital, ranging in age from one day to thirty-five months, were enrolled in this study from March 2021 to August 2021. All patients underwent imaging using a 3 T pediatric MR scanner, which included three sequences: 3D-UTE, 3D-T1 GRE, and T2-FSE. Subjective analyses were performed by two experienced pediatric radiologists based on a 5-point scale according to six pathological findings (patchy shadows/ground-glass opacity (GGO), consolidation, nodule, bulla/cyst, linear opacity, and pleural effusion/thickening). Additionally, they assessed image quality, including the presence of artifacts, and evaluated the lung parenchyma. Interrater agreement was assessed using intraclass correlation coefficients (ICCs). Differences among the three sequences were evaluated using the Wilcoxon signed-rank test.ResultsThe visualization of pathologies in most parameters (patchy shadows/GGO, consolidation, nodule, and bulla/cyst) was superior with UTE compared to T2-FSE and T1 GRE. The visualization scores for linear opacity were similar between UTE and T2-FSE, and both were better than T1-GRE. In the case of pleural effusion/thickening, T2-FSE outperformed the other sequences. However, statistically significant differences between UTE and other sequences were only observed for patchy shadows/GGO and consolidation. The overall image quality was superior or at least comparable with UTE compared to T2-FSE and T1-GRE. Interobserver agreements for all visual assessments were significant and rated “substantial” or “excellent.”ConclusionsIn conclusion, UTE MRI is a useful and promising method for evaluating pediatric pneumonia, as it provided better or similar visualization of most imaging findings compared with T2-FSE and T1-GRE. We suggest that the UTE MRI is well-suited for pediatric population, especially in younger children with pneumonia who require longitudinal and repeated imaging for clinical care or research and are susceptible to ionizing radiation.

Non-sedated fast spine magnetic resonance imaging in pediatric patients.

Traditional spine magnetic resonance imaging (MRI) protocols require sedation in young children and uncooperative patients. There is an increased interest in non-sedated pediatric MRI protocols to reduce risks associated with anesthetic agents and improve MRI access. To evaluate the image quality of pediatric non-sedated fast spine MRI. We retrospectively reviewed 69 pediatric non-sedated fast spine MRI exams performed in 57 patients. Two blinded readers provided image quality ratings for the evaluation of bones, cranio-cervical junction, cerebrospinal fluid (CSF) spaces, spinal cord, soft tissues, ligaments, and overall diagnostic quality on a 1-5 scale, and determined whether there was evidence of syringomyelia, abnormal conus medullaris position, or filum terminale abnormality. Mean patient age was 7.2years (age range ≤ 1-17). Indications included syringomyelia (n=25), spinal dysraphism (n=4), combination of both syringomyelia and spinal dysraphism (n=8), and other miscellaneous indications (n=32). The inter-observer agreement ranged between moderate and very good for each variable (Cohen's weighted kappa] range=0.45-0.69). The highest image quality ratings were given to CSF spaces (mean image quality=3.5/5 ± 0.8) and cranio-cervical junction evaluations (3.5/5 ± 0.9). Overall diagnostic quality was worst in the <5years group (P=0.006). Readers independently identified a cervical spinal cord syrinx in 6 cases, and 1mm spinal cord central canal dilation in one case. Readers agreed on the position of the conus medullaris in 92% of cases (23/25 cases). Non-sedated pediatric spine MRI can be an effective diagnostic test to evaluate for spine pathology, especially syringomyelia, Chiari malformation, and conus medullaris anatomy.

Right Ventricular Strain Analysis By Tissue Tracking Cardiac Magnetic Resonance Imaging In Pediatric Patients With End-Stage Renal Disease.

To investigate right ventricular (RV) volume and mass by cardiac magnetic resonance (CMR) and the added value of tissue tracking strain analysis as markers of RV dysfunction in pediatric patients with end-stage renal disease (ESRD) and preserved RV ejection fraction. Twenty-five children with ESRD and preserved RVEF (>50%) and 10 healthy control children were enrolled. Tissue tracking CMR was used to assess Global Longitudinal, circumferential (GCS), and radial short and long axes (GRS SAX and GRS LAX) RV strains in the patients group compared with controls. Correlations between strain parameters and other CMR parameters and clinical biomarkers were assessed. Binary logistic regression was used to test the independence of cofounders and detect their significance. RV end-diastolic volume and mass (RVMi) were significantly higher in patients (97.2±19.3 mL/m2 and 26.6±7gr/m2) than control (71±7.8 mL/m2 and 11.9±2 gr/m2, P values 0.000). All RV global strain parameters were significantly impaired in patients compared with control (all P values <0.05). RV Global Longitudinal was significantly correlated to LVEF (r=-0.416, P=0.039), LVEDVi (r=0.481, P=0.015), LVMi (r=0.562, P=0.004), and systolic blood pressure index (r=0.586, P=0.002). RV GRS (LAX) was significantly correlated to LV GCS (r=-0.462, P=0.020) and LV GRS (SAX) (r=0.454, P=0.023). GRS (SAX) and GCS demonstrated the highest diagnostic accuracy (area under curve: 0.82 and 0.81) to detect strain impairment. Univariate binary logistic regression with patients versus control as dependent variables identified LVMi, RV end-diastolic volume, RVMi, weight, body surface area, RV GCS, RV GRS (LAX), RV GRS (SAX), LV GCS, and LV GRS (SAX) as significantly correlated to patients with ESRD. When adjusted to other cofounders in the multivariable model, only RVMi remained as an independent significant cofounder (Odds ratio:0.395, P=0.046). RV global strain, volume, and mass by CMR are markers of RV dysfunction in ESRD pediatric patients with preserved RVEF.

Cervical spine flexion-extension radiography versus magnetic resonance imaging in pediatric patients following blunt traumatic injury

BackgroundIn pediatric trauma patients, 60–80% of spinal cord injuries involve the cervical vertebrae. While the American College of Radiology offers guidelines for best imaging practices in the setting of acute...

Sedation for Magnetic Resonance Imaging in Pediatric Patients: Complications and Future Measures

The use of sedation to examine children is common in hospitals. MRI examinations require sedation when applied to pediatric patients, because of the high magnetic field and noisy environment, but complications such as respiratory failure and cardiac arrest have occurred in Japan. Unfortunately, there is no risk-free sedation. In order to perform sedation safely, it is necessary to understand the Recommendation on pediatric sedation for MRI examinations, which was published in 2020. Restrictions on oral intake prior to the exam and the 2-4-6 rules must be adhered to in order to avoid vomiting, and patients must be monitored every 5 minutes during the exam. In addition, non-sedative MRI with the use of videos and preparation tools should be performed more often.

Evaluation of Sedation With Sevoflurane in Magnetic Resonance Imaging in Pediatric Patients

Evaluation of Sedation With Sevoflurane in Magnetic Resonance Imaging in Pediatric Patients

Outcomes of dexmedetomidine sedation for drug-induced sleep ciné magnetic resonance imaging studies in pediatric obstructive sleep apnea patients.

Dexmedetomidine is utilized as a sedative agent for drug-induced sleep cine magnetic resonance imaging studies due to its ability to mimic natural sleep and lack of respiratory depressant effects. The outcomes of dexmedetomidine sedation such as respiratory complications and unplanned admissions in obstructive sleep apnea patients undergoing these studies are currently unknown. To describe the outcomes of dexmedetomidine sedation for outpatient drug-induced sleep magnetic resonance imaging in pediatric patients with obstructive sleep apnea. This is a retrospective chart review conducted in pediatric patients with obstructive sleep apnea undergoing outpatient drug-induced sleep ciné magnetic resonance imaging studies with dexmedetomidine sedation. Demographics, comorbidities, polysomnography study results, vital signs, respiratory complications, airway interventions, successful completion of the scan, and unplanned hospital admissions were measured. We analyzed 337 patients aged 2-18years (median age of 11years). The imaging was completed with dexmedetomidine as the sole sedative agent in 61% (N=207) patients. Ketamine was administered as additional sedative agent in 36% (N=122) of the patients. There was no difference in sedation-related adverse events and respiratory complications with regard to the severity of sleep apnea with the exception of mild desaturation episodes (SpO2 85%-90%). Patients who received additional sedative agents had significantly longer recovery room stay (71.5 [44] vs 55 [39] minutes; 95% CI of difference [9 to 23min], p<0.001) and total periprocedural stay (164.5 [52] vs 138 [64] minutes; 95% CI of difference [17 to 35min], p<.001). Dexmedetomidine alone or along with ketamine provided acceptable sedation in majority of the patients with obstructive sleep apnea undergoing outpatient diagnostic sleep magnetic resonance imaging studies without significant respiratory adverse events regardless of the severity of sleep apnea. Sedation failure and unplanned admissions are rare, and routine planned admission may not be required for this patient population.

Extraosseous Signal Changes on Magnetic Resonance Imaging in Pediatric Patients with Early-Stage Lumbar Spondylolysis.

Purpose : To analyze extraosseous signal changes (ESCs) on magnetic resonance imaging (MRI) in pediatric patients with stress fractures occurring in the lamina. Methods : This study was a retrospective review of 69 consecutive pediatric patients with stress fractures occurring in the lamina. We analyzed MRI scans obtained at the first presentation. Results : We used mainly axial short tau inversion recovery images acquired through the pedicle of these 84 fracture sites to identify the ESCs. These were then divided into three groups: "invisible" when no ESC was detected, "periosteal" for ESC seen on only the dorsal side of the lamina, and "perimuscular" for ESC distinctly spread around / in the paravertebral muscles. In total, 78 (92.9%) fracture sites showed ESCs on the dorsal side of the lamina among which 72 ESCs were located on only the "dorsal" side, while 6 ESCs were on the ventral side against the transverse process. Conclusion : ESCs on MRI were detected in more than 90% of patients before stress fracture became apparent in the lamina, which was considered similar to findings of periosteal thickening / edema detected at the onset of stress fracture in long bone. J. Med. Invest. 68 : 136-139, February, 2021.

Clinical features and the role of magnetic resonance imaging in pediatric patients with intracranial hypertension.

Increased intracranial hypertension (IIH) is a defined clinical condition; however, an unsolved pathophysiologic background usually creates problems in its diagnosis and proper approach. The aim of this study was to emphasize the clinical conditions and brain magnetic resonce imaging (MRI) clues of pediatric patients, especially this clinical entity with high morbidity. Here, we review the etiology, clinical presentation, brain MRI findings, and prognosis of IIH in children. The symptoms' onset age ranged from 9months to 16years. Headache (81%), vomiting (37%), and diplopia (33.3%) were the most frequent symptoms. The most common etiologic factors were found to be obesity and dural venous sinus thrombosis. Cerebrospinal fluid (CSF) opening pressure had mean a mean value of 615.2 ± 248mm H2O. A significant relationship was found between visual field impairment and height of CSF pressure (p < 0.001). Optic nerve sheath enlargement (88.8%) and optic nerve tortuosity (85.1%) were found as the most common brain MRI findings. Slit-likeventricle (37%), venous sinus thrombosis (29.6%), posterior globe sclera flattening (29.6%), empty sella (25.9%), and intraocular protrusion of the optic nerve (14.8%) were the other findings. A significant relationship was found between CSF opening pressure and the presence of optic nerve tortuosity (p = 0.002), and distension of the optic nerve sheath (p = 0.006). All patients received acetazolamide, only one patient underwent lumboperitoneal shunt, and only one received steroids. In children, IIH can present with different etiologies and symptoms. Brain MRI provides crucial clues in diagnosis. Urgent diagnosis and treatment planning are required to protect vision functions.

Intravenous gadolinium-based hepatocyte-specific contrast agents (HSCAs) for contrast-enhanced liver magnetic resonance imaging in pediatric patients: what the radiologist should know.

Hepatocyte-specific contrast agents (HSCAs) are a group of intravenous gadolinium-based MRI contrast agents that can be used to characterize hepatobiliary pathology. The mechanism by which these agents are taken up by hepatocytes and partially excreted into the biliary tree improves characterization of hepatic lesions and biliary abnormalities relative to conventional extracellular gadolinium-based contrast agents (GBCAs). This manuscript presents an overview of HSCA use in pediatric patients with the intent to provide radiologists a guide for clinical use. We review available HSCAs and discuss dosing and age specifications for use in children. We also review various hepatic and biliary indications for HSCA use in children, with emphasis on the imaging characteristics distinct to HSCAs, as well as discussion of pitfalls one can encounter when imaging with HSCAs. Given the growing concern regarding gadolinium deposition in soft tissues and brain, we also discuss safety of HSCA use in children.

Intracranial Gadolinium Deposition Following Gadodiamide-Enhanced Magnetic Resonance Imaging in Pediatric Patients

Intracranial Gadolinium Deposition Following Gadodiamide-Enhanced Magnetic Resonance Imaging in Pediatric Patients

Comparison between intranasal dexmedetomidine and intranasal midazolam as premedication for brain magnetic resonance imaging in pediatric patients: A prospective randomized double blind trial

Background and Aims:Preprocedural preparation of children scheduled for magnetic resonance imaging (MRI) is challenging. This prospective, randomized trial compared intranasal midazolam with intranasal dexmedetomidine as premedication for children scheduled for brain MRI.Material and Methods:In total, 60 children, aged 1–8 years, scheduled for elective brain MRI, were randomly assigned to the intranasal dexmedetomidine (1 μg/kg; Group D) or intranasal midazolam (0.2 mg/kg; Group M) group. We compared hemodynamic and respiratory parameters, onset, level, sedation quality, and successful parental separation. All patients received intravenous propofol as an induction and maintenance agent for MRI.Results:No significant differences were observed in demographic, hemodynamic, and respiratory parameters. Group D (14.3 ± 3.4 min [10–20 min]) had a longer time of sedation onset than Group M (8.7 ± 3.7 min [5–15 min]; P < 0.001). The median and mean sedation scores were lower in Group D (3 and 3.7 ± 0.8, respectively) than Group M (4 and 4.3 ± 1.2, respectively; P = 0.055). Group D (80%) had a higher percentage of children achieving satisfactory sedation at the time of induction than did Group M (53.3%; P = 0.0285). Parental separation was successful in 73.3% of patients in Group D compared with 46.7% of patients in Group M (P = 0.035).Conclusion:Intranasal dexmedetomidine results in more successful parental separation and yields a higher sedation level at the time of induction of anesthesia than intranasal midazolam as premedication, with negligible side effects. However, its onset of action is relatively prolonged.

Efficacy and safety of intravenous thiopental for sedation during magnetic resonance imaging in pediatric patients: A retrospective analysis.

Introduction:Although the administration of rectal thiopental for sedation during magnetic resonance imaging (MRI) has been well described, there are limited data regarding its intravenous (IV) use in this clinical scenario. The aim of this study was to investigate the efficiency of IV thiopental for sedation during MRI in the pediatric population.Methods:A retrospective review was conducted over a 12-month period of pediatric patients who received IV thiopental for sedation during MRI. Data collected included the procedure length, the induction dose, the time to sedation, recovery time, total sedation time, and adverse events. The parents were telephoned and questioned regarding any adverse effect after discharge and their satisfaction (yes = satisfied; no = not satisfied) regarding the sedation process.Results:A total of 300 (American Society of Anesthesiology I–II status) pediatric patients received IV thiopental for sedation during MRI. The average age of the patients was 4.7 ± 3 years. Thiopental was administered as an initial IV bolus dose of 3 mg/kg, followed by additional bolus doses of thiopental (1 mg/kg) as needed to achieve a Ramsay sedation score of 4. The average procedure length was 20.7 ± 11.9 min. The average total dose of thiopental during the procedure was 5.6 ± 0.9 mg/kg. Patients recovered in an average time of 11 ± 5.6 min after a total sedation time of 31.7 ± 14.2 min. None of the patients had oxygen desaturation, adverse effects before or after discharge, and no patient required unplanned hospital admission. All parents were satisfied with the sedation process.Conclusion:IV thiopental is an effective, safe, and inexpensive medication for the sedation of children undergoing MRI.

The Effectiveness of Brain Magnetic Resonance Imaging in Pediatric Patients with various neurologic symptoms

The Effectiveness of Brain Magnetic Resonance Imaging in Pediatric Patients with various neurologic symptoms

Cardiac magnetic resonance imaging in pediatric patients ≤ 18 years with suspected arrhythmogenic right ventricular cardiomyopathy (ARVC): a correlation to genetics

Background Arrhythmogenic right ventricular cardiomyopathy (ARVC) is associated with increased risk of sudden cardiac death. It is a progressive disease that can already manifest itself during childhood and adolescence. Since little is known about the early stage in pediatric patients, this study sought to determine the influence of right and left ventricular findings from cardiac magnetic resonance imaging (CMR) in pediatric patients ≤ 18 years with suspected ARVC in conjunction with positive genetic testing.

Contrast-enhanced magnetic resonance imaging in pediatric patients: review and recommendations for current practice.

Magnetic resonance imaging (MRI), frequently with contrast enhancement, is the preferred imaging modality for many indications in children. Practice varies widely between centers, reflecting the rapid pace of change and the need for further research. Guide-line changes, for example on contrast-medium choice, require continued practice reappraisal. This article reviews recent developments in pediatric contrast-enhanced MRI and offers recommendations on current best practice. Nine leading pediatric radiologists from internationally recognized radiology centers convened at a consensus meeting in Bordeaux, France, to discuss applications of contrast-enhanced MRI across a range of indications in children. Review of the literature indicated that few published data provide guidance on best practice in pediatric MRI. Discussion among the experts concluded that MRI is preferred over ionizing-radiation modalities for many indications, with advantages in safety and efficacy. Awareness of age-specific adaptations in MRI technique can optimize image quality. Gadolinium-based contrast media are recommended for enhancing imaging quality. The choice of most appropriate contrast medium should be based on criteria of safety, tolerability, and efficacy, characterized in age-specific clinical trials and personal experience.

Poor Accuracy of Noninvasive Cardiac Output Monitoring Using Bioimpedance Cardiography [PhysioFlow®] Compared to Magnetic Resonance Imaging in Pediatric Patients

Taylor, Katherine*†; Manlhiot, Cedric*†; McCrindle, Brian*; Grosse-Wortmann, Lars*; Holtby, Helen*Author Information

Infantile Fibromatosis of the Pterygomandibular Space

Infantile fibromatosis (IF) is a benign, nonmetastasizing but locally aggressive tumor. Pterygomandibular space is deep and obscure, and IF in this space is seldom reported. We describe a typical case of IF in the pterygomandibular space that occurred in a 3-year-old girl. Intraoral incisional biopsy revealed the diagnosis of IF, and surgical resection of the tumor was performed. We intend to heighten the awareness of this tumor and emphasize the pathologic features and identifications of IF and discuss the diagnosis and treatment of this disease. For the high recurrence risk, follow-up with clinical examination and magnetic resonance imaging in pediatric patients is recommended.