We thank participating children and families, all staff at the Children's Hospital Boston (CHB) with special appreciation to the MRI technicians, without whom our studies could not be conducted. We are especially grateful to Arnold Cyr for participation and help during our video shoot and to operation manager Patricia Devine at the CHB Waltham. Thanks to the research and technical staff at MIT's Athinoula A. Martinos Imaging Center for sharing experience in MR image acquisition and analysis.
This research was funded by the Charles H. Hood Foundation, a Children's Hospital Boston pilot grant and the Swiss National Foundation (N.M.R.)

We 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 ma...

<ol>
	<li>Boecker, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Current+stage+of+fMRI+applications+in+newborns+and+children+during+the+first+year+of+life.">Current stage of fMRI applications in newborns and children during the first year of life.</a> Rofo. 180 (8), 707-714 (2008).</li><li>Bookheimer, S. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Methodological+issues+in+pediatric+neuroimaging.">Methodological issues in pediatric neuroimaging.</a> Ment Retard Dev Disabil Res Rev. 6 (3), 161-165 (2000).</li><li>Souweidane, M. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Brain+mapping+in+sedated+infants+and+young+children+with+passive-functional+magnetic+resonance+imaging.">Brain mapping in sedated infants and young children with passive-functional magnetic resonance imaging.</a> Pediatr Neurosurg. 30 (2), 86-92 (1999).</li><li>Poldrack, R. A., Pare-Blagoev, E. J., Grant, P. E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pediatric+functional+magnetic+resonance+imaging:+progress+and+challenges.">Pediatric functional magnetic resonance imaging: progress and challenges.</a> Top Magn Reson Imaging. 13 (1), 61-70 (2002).</li><li>Macmaster, F. P., Rosenberg, D. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Preparing+children+for+MRI.">Preparing children for MRI.</a> Pediatr Radiol. 38 (3), 270-270 (2008).</li><li>Wilke, M., Holland, S. K., Myseros, J. S., Schmithorst, V. J., Ball, W. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Functional+magnetic+resonance+imaging+in+pediatrics.">Functional magnetic resonance imaging in pediatrics.</a> Neuropediatrics. 34 (5), 225-233 (2003).</li><li>Davidson, M. C., Thomas, K. M., Casey, B. J., J, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Imaging+the+developing+brain+with+fMRI.">Imaging the developing brain with fMRI.</a> Ment Retard Dev Disabil Res Rev. 9 (3), 161-167 (2003).</li><li>Sury, M. R., Harker, H., Begent, J., Chong, W. K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+management+of+infants+and+children+for+painless+imaging.">The management of infants and children for painless imaging.</a> Clin Radiol. 60 (7), 731-741 (2005).</li><li>Hunt, R. H., Thomas, K. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Magnetic+resonance+imaging+methods+in+developmental+science:+a+primer.">Magnetic resonance imaging methods in developmental science: a primer.</a> Dev Psychopathol. 20 (4), 1029-1051 (2008).</li><li>O'Shaughnessy, E. S., Berl, M. M., Moore, E. N., Gaillard, W. D., D, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Pediatric+functional+magnetic+resonance+imaging+(fMRI):+issues+and+applications.">Pediatric functional magnetic resonance imaging (fMRI): issues and applications.</a> J Child Neurol. 23 (7), 791-801 (2008).</li><li>Raschle, N. M., Chang, M., Lee, M., Buechler, R., Gaab, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Examining+Behavioral+and+Neural+Pre-Markers+of+Developmental+Dyslexia+in+Children+Prior+to+Reading+Onset.">Examining Behavioral and Neural Pre-Markers of Developmental Dyslexia in Children Prior to Reading Onset.</a> , (1985).</li><li>Pressdee, D., May, L., Eastman, E., Grier, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+use+of+play+therapy+in+the+preparation+of+children+undergoing+MR+imaging.">The use of play therapy in the preparation of children undergoing MR imaging.</a> Clin Radiol. 52 (12), 945-947 (1997).</li><li>Slifer, K. J., Cataldo, M. F., Cataldo, M. D., Llorente, A. M., Gerson, A. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Behavior+analysis+of+motion+control+for+pediatric+neuroimaging.">Behavior analysis of motion control for pediatric neuroimaging.</a> J Appl Behav Anal. 26 (4), 469-470 (1993).</li><li>Slifer, K. J., Bucholtz, J. D., Cataldo, M. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Behavioral+training+of+motion+control+in+young+children+undergoing+radiation+treatment+without+sedation.">Behavioral training of motion control in young children undergoing radiation treatment without sedation.</a> J Pediatr Oncol Nurs. 11 (2), 55-63 (1994).</li><li>Slifer, K. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+video+system+to+help+children+cooperate+with+motion+control+for+radiation+treatment+without+sedation.">A video system to help children cooperate with motion control for radiation treatment without sedation.</a> J Pediatr Oncol Nurs. 13 (2), 91-97 (1996).</li><li>Tyc, V. L., Fairclough, D., Fletcher, B., Leigh, L., Mulhern, R. K., K, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Children's+distress+during+magnetic+resonance+imaging+procedures.">Children's distress during magnetic resonance imaging procedures.</a> Child Health Care. 24 (1), 5-19 (1995).</li><li>Slifer, K. J., Koontz, K. L., Cataldo, M. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Operant-contingency-based+preparation+of+children+for+functional+magnetic+resonance+imaging.">Operant-contingency-based preparation of children for functional magnetic resonance imaging.</a> J Appl Behav Anal. 35 (2), 191-194 (2002).</li><li>Byars, A. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Practical+aspects+of+conducting+large-scale+functional+magnetic+resonance+imaging+studies+in+children.">Practical aspects of conducting large-scale functional magnetic resonance imaging studies in children.</a> J Child Neurol. 17 (12), 885-890 (2002).</li><li>Rosenberg, D. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Magnetic+resonance+imaging+of+children+without+sedation:+preparation+with+simulation.">Magnetic resonance imaging of children without sedation: preparation with simulation.</a> J Am Acad Child Adolesc Psychiatry. 36 (6), 853-859 (1997).</li><li>de Amorim e Silva, C. J., Mackenzie, A., Hallowell, L. M., Stewart, S. E., Ditchfield, M. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Practice+MRI:+reducing+the+need+for+sedation+and+general+anaesthesia+in+children+undergoing+MRI.">Practice MRI: reducing the need for sedation and general anaesthesia in children undergoing MRI.</a> Australas Radiol. 50 (4), 319-323 (2006).</li><li>Epstein, J. N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessment+and+prevention+of+head+motion+during+imaging+of+patients+with+attention+deficit+hyperactivity+disorder.">Assessment and prevention of head motion during imaging of patients with attention deficit hyperactivity disorder.</a> Psychiatry Res. 155 (1), 75-82 (2007).</li><li>Lukins, R., Davan, I. G., Drummond, P. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+cognitive+behavioural+approach+to+preventing+anxiety+during+magnetic+resonance+imaging.">A cognitive behavioural approach to preventing anxiety during magnetic resonance imaging.</a> J Behav Ther Exp Psychiatry. 28 (2), 97-104 (1997).</li><li>Hallowell, L. M., Stewart, S. E., Amorim, E. S. C. T. d. e., Ditchfield, M. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Reviewing+the+process+of+preparing+children+for+MRI.">Reviewing the process of preparing children for MRI.</a> Pediatr Radiol. 38 (3), 271-279 (2008).</li><li>Preston, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Testing children : a practitioner's guide to the assessment of mental development in infants and young children. , (2005).</li><li>Kotsoni, E., Byrd, D., Casey, B. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Special+considerations+for+functional+magnetic+resonance+imaging+of+pediatric+populations.">Special considerations for functional magnetic resonance imaging of pediatric populations.</a> J Magn Reson Imaging. 23 (6), 877-886 (2006).</li><li>Armstrong, T. S., Aitken, H. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+developing+role+of+play+preparation+in+paediatric+anaesthesia.">The developing role of play preparation in paediatric anaesthesia.</a> Paediatr Anaesth. 10 (1), 1-4 (2000).</li><li>Garcia-Palacios, A., Hoffman, H. G., Richards, T. R., Seibel, E. J., Sharar, S. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+virtual+reality+distraction+to+reduce+claustrophobia+symptoms+during+a+mock+magnetic+resonance+imaging+brain+scan:+a+case+report.">Use of virtual reality distraction to reduce claustrophobia symptoms during a mock magnetic resonance imaging brain scan: a case report.</a> Cyberpsychol Behav. 10 (3), 485-488 (2007).</li><li>Cho, Z. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Analysis+of+acoustic+noise+in+MRI.">Analysis of acoustic noise in MRI.</a> Magn Reson Imaging. 15 (7), 815-822 (1997).</li><li>Gaab, N., Gabrieli, J. D., Glover, G. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessing+the+influence+of+scanner+background+noise+on+auditory+processing.+I.+An+fMRI+study+comparing+three+experimental+designs+with+varying+degrees+of+scanner+noise.">Assessing the influence of scanner background noise on auditory processing. I. An fMRI study comparing three experimental designs with varying degrees of scanner noise.</a> Hum Brain Mapp. 28 (8), 703-720 (2007).</li><li>Gaab, N., Gabrieli, J. D., Glover, G. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Assessing+the+influence+of+scanner+background+noise+on+auditory+processing.+II.+An+fMRI+study+comparing+auditory+processing+in+the+absence+and+presence+of+recorded+scanner+noise+using+a+sparse+design.">Assessing the influence of scanner background noise on auditory processing. II. An fMRI study comparing auditory processing in the absence and presence of recorded scanner noise using a sparse design.</a> Hum Brain Mapp. 28 (8), 721-732 (2007).</li><li>Bilecen, D., Radu, E. W., Scheffler, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+MR+tomograph+as+a+sound+generator:+fMRI+tool+for+the+investigation+of+the+auditory+cortex.">The MR tomograph as a sound generator: fMRI tool for the investigation of the auditory cortex.</a> Magn Reson Med. 40 (6), 934-937 (1998).</li><li>Eden, G. F., Joseph, J. E., Brown, H. E., Brown, C. P., Zeffiro, T. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Utilizing+hemodynamic+delay+and+dispersion+to+detect+fMRI+signal+change+without+auditory+interference:+the+behavior+interleaved+gradients+technique.">Utilizing hemodynamic delay and dispersion to detect fMRI signal change without auditory interference: the behavior interleaved gradients technique.</a> Magn Reson Med. 41 (1), 13-20 (1999).</li><li>Belin, P., Zatorre, R. J., Hoge, R., Evans, A. C., Pike, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Event-related+fMRI+of+the+auditory+cortex.">Event-related fMRI of the auditory cortex.</a> Neuroimage. 10 (4), 417-429 (1999).</li><li>Gaab, N., Gaser, C., Zaehle, T., Jancke, L., Schlaug, G., G, . <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Functional+anatomy+of+pitch+memory--an+fMRI+study+with+sparse+temporal+sampling.">Functional anatomy of pitch memory--an fMRI study with sparse temporal sampling.</a> Neuroimage. 19 (4), 1417-1426 (2003).</li><li>Hall, D. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term="Sparse"+temporal+sampling+in+auditory+fMRI.">"Sparse" temporal sampling in auditory fMRI.</a> Hum Brain Mapp. 7 (3), 213-223 (1999).</li><li>Gaab, N., Gabrieli, J. D., Glover, G. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Resting+in+peace+or+noise:+scanner+background+noise+suppresses+default-mode+network.">Resting in peace or noise: scanner background noise suppresses default-mode network.</a> Hum Brain Mapp. 29 (7), 858-867 (2008).</li></ol>

The emergence of functional and structural MRI to study the human brain has facilitated possibilities of examining typical as well as atypical brain structure and functions and therefore holds great promise for both research and clinical purposes 6. However, MRI studies in younger age groups remain less numerous when compared to those of adults, adolescents or infants, which is mainly due to technical and practical difficulties when performing pediatric neuroimaging sessions. The curr...

making mr imaging child's play - pediatric neuroimaging protocol, guidelines and procedure

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 environment2,4-10. 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, 16-18 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.

Watch this Scientific Journal Video about Making MR Imaging Child's Play - Pediatric Neuroimaging Protocol, Guidelines and Procedure at JoVE.com

Making MR Imaging Child&#039;s Play - Pediatric Neuroimaging Protocol, Guidelines and Procedure

Despite an increase in the use of structural and functional magnetic resonance imaging (fMRI) in humans, the study of young pediatric populations remains a challenge. We present a hands-on, step-by-step video protocol including guidelines for clinicians and researchers intending to perform (f)MRI in young children.

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

Within the last decade there has been an increase in the use of structural and functional magnetic resonance imaging (fMRI) to investigate the neural ...

making-mr-imaging-child-s-play-pediatric-neuroimaging-protocol

Research

JoVE Journal

Biology

18.0K vistas.  Children’s Hospital Boston. A pesar del aumento en el uso de la resonancia estructural y magnética funcional (fMRI) en los seres humanos, el estudio de la joven población infantil sigue siendo un desafío. Se presenta un práctico, paso a paso el protocolo de video, incluyendo directrices para los médicos e investigadores con la intención de realizar (f) de resonancia magnética en niños pequeños.