Making MR Imaging Child's Play - Pediatric Neuroimaging Protocol, Guidelines and Procedure

Abstract

Within the last decade there has been an increase in the use of structural and functional magnetic resonance imaging (fMRI) to investigate the neural basis of human perception, cognition and behavior 1, 2 . Moreover, this non-invasive imaging method has grown into a tool for clinicians and researchers to explore typical and atypical brain development. Although advances in neuroimaging tools and techniques are apparent, (f)MRI in young pediatric populations remains relatively infrequent 2 . Practical as well as technical challenges when imaging children present clinicians and research teams with a unique set of problems 3, 2 . To name just a few, the child participants are challenged by a need for motivation, alertness and cooperation. Anxiety may be an additional factor to be addressed. Researchers or clinicians need to consider time constraints, movement restriction, scanner background noise and unfamiliarity with the MR scanner environment 2,4-10 . A progressive use of functional and structural neuroimaging in younger age groups, however, could further add to our understanding of brain development. As an example, several research groups are currently working towards early detection of developmental disorders, potentially even before children present associated behavioral characteristics e.g.11 . Various strategies and techniques have been reported as a means to ensure comfort and cooperation of young children during neuroimaging sessions. Play therapy 12 , behavioral approaches 13,14,15,[16][17][18] and simulation 19 , the use of mock scanner areas 20,21 , basic relaxation 22 and a combination of these techniques 23 have all been shown to improve the participant's compliance and thus MRI data quality. Even more importantly, these strategies have proven to increase the comfort of families and children involved 12 . One of the main advances of such techniques for the clinical practice is the possibility of avoiding sedation or general anesthesia (GA) as a way to manage children's compliance during MR imaging sessions 19,20 . In the current video report, we present a pediatric neuroimaging protocol with guidelines and procedures that have proven to be successful to date in young children. ProtocolWe have incorporated general experimental testing guidelines as well as MRI specific approaches 12-23 into one complete neuroimaging protocol intended to guide researchers and clinicians during neuroimaging sessions with awake children as young as four years of age. First, we aim to emphasize general testing guidelines adapted for MRI examinations. Second, we provide a hands-on, step-by-step description of our neuroimaging protocol. In our experience, a single session of approximately 2.5 hours (including a maximal imaging time of 45-60 minutes) is sufficient to train and guide a child through a neuroimaging session. General GuidelinesAs in every testing session with pediatric populations, general guidelines and recommendations for how best to work with young children should be considered 24 . We highlight comfor...

Erratum to: Brief Report: Approaches to 31P-MRS in Awake, Non-Sedated Children With and Without Autism Spectrum Disorder

“…Our findings comport with and extend prior reports: Children pose greater obstacles for magnetic resonance scanning (Raschle et al 2009;Poldrack et al 2002), and challenges are greater with younger age (Kern et al 2006;Byars et al 2002;Yerys et al 2009) and magnified with conditions such as ASD (Kern et al 2006;Yerys et al 2009). We built on others' successes, and findings support relaxation (Raschle et al 2009), high-quality personal interactions (Poldrack et al 2002;Clark and Rutter 1981), and strong parental input (Nordahl et al 2008) to enhance comfort and compliance.…”

“…Successful completion of MR protocols is often compromised by participant inattention and non-compliance (Corbett and Constantine 2006;Sturm et al 2004), anxiety (Gillott and Standen 2007;Gillott et al 2001), fatigue, and sensory (auditory and tactile) sensitivity (Cascio et al 2008;Kern et al 2006;Rogers et al 2003), leading to higher failure rates in younger children (Raschle et al 2009;Poldrack et al 2002;Byars et al 2002) and those with conditions such as ASD (Yerys et al 2009). …”

“…Use of natural sleep (Almli et al 2007;Nordahl et al 2008) and mock scanners (Rosenberg et al 1997) have been heralded as fostering scanning success without pharmacologic intervention (Raschle et al 2009;Nordahl et al 2008). However, sleep or sedation may still alter functional and energetic characteristics of the brain (germane to fMRI, 31 P-MRS) (Scharf et al 2008;Dworak et al 2010), and energetic assessments may benefit from muscle exercise/ recovery testing that necessarily requires non-sleeping, nonsedated subjects.…”

Functional characteristics of developmental dyslexia in left-hemispheric posterior brain regions predate reading onset

“…The participants' in-scanner performance was closely monitored (for details see ref. 81). To ensure that the participants were engaged in the tasks, participants with more than 40% of trials unanswered were excluded from the imaging analyses.…”

Child Life Services

“…In addition to reducing anxiety and providing a more positive experience for the patient and family, research demonstrates that preparation and coping facilitation interventions decrease the need for sedation in procedures such as MRIs, resulting in lower risks for the child and cost savings in personnel, anesthesia, and throughputrelated expenses. [35][36][37] Preparation techniques, materials, and language must be adapted to the developmental level, personality, and unique experiences of the child and his or her family. Learning is enhanced with "hands-on" methods versus exclusively verbal explanations.…”