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

Summary

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.

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, 16-18} 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.

Protocol

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 maximal imaging time of 45-60 minutes) is sufficient to train and guide a child through a neuroimaging session.

General Guidel....

Discussion

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.......