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Sawada N, Kawada JI, Kito S, Takeo T, Narita H, Fukushima M, Masuda Y, Mitsumatsu T, Kawano Y, Sakaguchi Y, Nishio N, Kidokoro H, Sato Y, Takahashi Y. Application of simple preparation for pediatric magnetic resonance imaging: a multicenter study in Japan. Pediatr Radiol 2025; 55:976-982. [PMID: 39976708 DOI: 10.1007/s00247-025-06194-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2024] [Revised: 01/23/2025] [Accepted: 02/05/2025] [Indexed: 05/11/2025]
Abstract
BACKGROUND Sedation with anesthetic medication is often required to perform magnetic resonance imaging (MRI) scans in young children. However, sedation involves risks, particularly respiratory depression. Therefore, it is crucial to explore methods enabling young children to undergo MRI scans without sedation. Additionally, developing MRI preparation techniques for young children that are feasible in general hospitals-without specialized staff or equipment-has become increasingly desirable. OBJECTIVE This study aimed to develop a straightforward preparation method for pediatric MRI scans and evaluate its effectiveness. MATERIALS AND METHODS We prospectively enrolled 43 children ages 4-6 years (mean age, 5.8 years) who were scheduled for MRI scans at five general hospitals. Patients requiring urgent MRI scans were excluded from the study. We provided simple preparations created by child life specialists to help children and guardians easily understand MRI scans. A historical control group comprised 44 consecutive children, ages 4-6 years, who had undergone MRI scans before this preparatory intervention was introduced. RESULTS Following the introduction of the preparation, a significantly higher percentage of patients attempted MRI scans without sedation than historical controls (60.5% vs. 15.9%, P < 0.001). Additionally, the success rate of performing MRI without sedation increased markedly (53.5% vs. 13.6%, P < 0.001). CONCLUSION Introducing the simple preparation allowed for more successful non-sedated MRI scans in children ages 4-6 years. This preparation may contribute to higher rates of successful non-sedated MRIs among children in general hospitals, even in settings lacking specialized staff or equipment.
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Affiliation(s)
- Naomi Sawada
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Jun-Ichi Kawada
- Nagoya University Graduate School of Medicine, Nagoya, Japan.
- Department of Pediatrics, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan.
| | - Shuichi Kito
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshiki Takeo
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hajime Narita
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mai Fukushima
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yu Masuda
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | | | | | - Nobuhiro Nishio
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Yoshiaki Sato
- Nagoya University Graduate School of Medicine, Nagoya, Japan
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Oh B, Oh E, Lee VSH, Francisco KLF, Teo R, Hoon D, Taylor R. Implementing a fantasy space-themed video distraction programme to reduce sedation in paediatric MRI. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2025; 54:257-259. [PMID: 40324894 DOI: 10.47102/annals-acadmedsg.2024323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2025]
Abstract
Dear Editor,
Magnetic resonance imaging (MRI) is an important diagnostic imaging modality, especially in children where radiation exposure is an important concern. As children undergoing MRI scans need to lie still for an extended period of time in an environment with loud noises, sedation is often required.1 However, its use comes with risks of adverse cardiorespiratory events2-3 and utilisation of hospital resources when children are admitted for monitoring post-sedation. Optimising the MRI environment, distraction techniques and the use of mock scanners minimises the need for sedation in children.4-8 A multifaceted approach, which combines these components, has been shown to be effective in children as young as 4 years old.9-10
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Affiliation(s)
- Bernice Oh
- Viva-University Children's Cancer Centre, National University Hospital, Singapore
- Division of Paediatric Haematology and Oncology, Department of Paediatrics, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, Singapore
| | - Eileen Oh
- Children's Emergency, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, Singapore
| | - Vivian Shan Hui Lee
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Regine Teo
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Desmond Hoon
- Department of Diagnostic Imaging, National University Hospital, Singapore
| | - Ryan Taylor
- Division of Paediatric Critical Care, Department of Paediatrics, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, Singapore
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Bruno JL, Merrin JJ, Hosseini SMH, Green T. A familial modeling framework for advancing precision medicine for children with neuropsychiatric disorders. Dev Med Child Neurol 2025. [PMID: 40119877 DOI: 10.1111/dmcn.16278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 01/17/2025] [Accepted: 01/22/2025] [Indexed: 03/24/2025]
Abstract
AIM To provide individualized estimates of expected child neuropsychiatric and neuroanatomical outcomes by using parent cognitive and behavioral traits in a predictive framework. METHOD Predictive modeling was applied to 52 families of children with Noonan syndrome, a neurogenetic syndrome affecting the Ras/mitogen-activated protein kinase (MAPK) pathway. RESULTS Parent cognition (specifically visuospatial and motor abilities), depression, anxiety, and attention-deficit/hyperactivity disorder symptoms were significantly associated with child outcomes in these domains. Parent cognition was also significantly associated with child neuroanatomical variability. The middle temporal cortex was weighted strongly in the model predicting child neuroanatomy and not identified in previous work, but was correlated with parent cognition, suggesting a larger familial effect in this region. INTERPRETATION Using parent traits provides a more individualized estimate of expected child cognitive, behavioral, and neuroanatomical outcomes. Understanding how parent traits influence neuroanatomical outcomes helps to further a mechanistic understanding of the impact of Ras/MAPK on neurodevelopmental outcomes. Further refinement of predictive modeling to estimate individualized child outcomes will advance a precision medicine approach to treating Noonan syndrome, other neurogenetic syndromes, and neuropsychiatric disorders more broadly.
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Affiliation(s)
- Jennifer L Bruno
- Division of Interdisciplinary Brain Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Jacob Joseph Merrin
- Division of Interdisciplinary Brain Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - S M Hadi Hosseini
- Division of Interdisciplinary Brain Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Tamar Green
- Division of Interdisciplinary Brain Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
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Runge SB, Precht H, Jensen IE, Jensen K, Johannesen TA, Pedersen MRV, Christensen NL. Children Centered Care: child and parent perspectives on a multi-faceted concept for magnetic resonance imaging without anesthesia - a survey. Pediatr Radiol 2025; 55:334-346. [PMID: 39661172 PMCID: PMC11805776 DOI: 10.1007/s00247-024-06111-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 11/12/2024] [Accepted: 11/13/2024] [Indexed: 12/12/2024]
Abstract
BACKGROUND Anxiety-provoking healthcare procedures require specific child-friendly approaches. Magnetic resonance imaging (MRI) can cause anxiety for children and general anesthesia (GA) is often used. We developed and tested a multi-faceted child-friendly concept, Children Centered Care, for MRI of children without GA. OBJECTIVE To investigate children's and parents' individual experiences with the concept using a survey. The main aim was to evaluate comfort for children and sense of security for parents during unsedated MRI. MATERIALS AND METHODS In this prospective study of 265 children aged 4-10 years enrolled in 2016 and 2017, the Children Centered Care concept is compared to a standard setup. The concept included an interactive app, trained pediatric radiographers, a children's lounge with a toy-scanner, and a child-friendly multimedia environment in the scanner room. A 25-item survey was used including a mix of open and closed questions, free text, and a visual analogue scale to evaluate self-reported child comfort. RESULTS A total of 154 children were included in the Children Centered Care group and 111 in the standard group. Overall, the mean age was 8.5 years (range 4.0-10.9 years). With Children Centered Care, child comfort increased (88% vs. 77%), P = 0.02. The app and toy-scanner were popular among children. More parents felt "very much" prepared (80% vs. 57%), P < 0.01, and "very much" secure (92% vs. 79%), P < 0.01. CONCLUSION With the use of a multi-faceted, child-friendly concept, MRI without GA is a feasible first choice for children aged 4-10 years, with high levels of comfort for children and parents.
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Affiliation(s)
- Stine Bjerrum Runge
- Department of Radiology, Lillebaelt Hospital Kolding, Sygehusvej 24, 6000, Kolding, Denmark.
| | - Helle Precht
- Department of Radiology, Lillebaelt Hospital Kolding, Sygehusvej 24, 6000, Kolding, Denmark
- Department of Regional Health Research, Odense, Denmark
- Health Sciences Research Center, UCL University College, Odense, Denmark
| | - Ib Erik Jensen
- Department of Radiology, Lillebaelt Hospital Kolding, Sygehusvej 24, 6000, Kolding, Denmark
- Department of Radiology, Odense University Hospital, Odense, Denmark
| | - Kim Jensen
- Department of Radiology, Lillebaelt Hospital Kolding, Sygehusvej 24, 6000, Kolding, Denmark
- Progardia, Middelfart, Denmark
| | | | - Malene Roland Vils Pedersen
- Department of Radiology, Lillebaelt Hospital Kolding, Sygehusvej 24, 6000, Kolding, Denmark
- Department of Radiology, Lillebaelt Hospital Vejle, Vejle, Denmark
- Department of Regional Health Research, Odense, Denmark
| | - Nicolaj Lyhne Christensen
- Department of Radiology, Lillebaelt Hospital Kolding, Sygehusvej 24, 6000, Kolding, Denmark
- Department of Radiology, Odense University Hospital, Odense, Denmark
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Foland-Ross LC, Jordan TL, Marzelli MJ, Ross JL, Reiss AL. Neuroanatomical alterations in young boys and adolescents with Klinefelter syndrome. Psychiatry Res Neuroimaging 2025; 346:111929. [PMID: 39637706 PMCID: PMC11706219 DOI: 10.1016/j.pscychresns.2024.111929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 10/30/2024] [Accepted: 11/25/2024] [Indexed: 12/07/2024]
Abstract
Klinefelter syndrome (KS, 47,XXY) is a common sex chromosome aneuploidy in males that is characterized by pubertal developmental delays and a wide range of alterations in cognitive, social and emotional functioning. The neural bases of these behavioral symptoms, however, are unclear. A total of 130 boys and adolescents, including 67 males with KS (11.5 ± 2.8 years) and 63 typically developing (TD; control) males (10.6 ± 2.8 years) underwent MRI scanning and pubertal assessment. Group differences in regional gray matter volume was examined using voxel-based morphometry while controlling for age at scan and total gray matter volume. Thresholded statistical significance maps indicated widespread reductions in frontal and temporal and cerebellar gray matter in males with KS relative to TD males, as well as increases in parietal and occipital gray matter. Secondary analyses explored potential associations between GMV in these regions and pubertal development. Lower testicular volume was a significant predictor of reduced GMV in frontal, temporal and cerebellar subregions, even after accounting for group status (KS, TD). Taken together, these findings add support for a neuroanatomical phenotype of KS and provide initial evidence for a role of pubertal development in KS-associated differences in gray matter structure. Future studies that examine the influence of testosterone supplementation on GMV in males with KS are warranted.
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Affiliation(s)
- Lara C Foland-Ross
- Stanford University School of Medicine, Department of Psychiatry and Biobehavioral Sciences, 1520 Page Mill Road, Stanford, California, 94305, United States.
| | - Tracy L Jordan
- Stanford University School of Medicine, Department of Psychiatry and Biobehavioral Sciences, 1520 Page Mill Road, Stanford, California, 94305, United States
| | - Matthew J Marzelli
- Stanford University School of Medicine, Department of Psychiatry and Biobehavioral Sciences, 1520 Page Mill Road, Stanford, California, 94305, United States
| | - Judith L Ross
- Department of Pediatrics, Division of Endocrinology, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, United States
| | - Allan L Reiss
- Stanford University School of Medicine, Department of Psychiatry and Biobehavioral Sciences, 1520 Page Mill Road, Stanford, California, 94305, United States; Stanford University School of Medicine, Department of Radiology, United States; Stanford University School of Medicine, Department of Pediatrics, United States
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Gerrish AC, Malik L, Swain C, Thomas AG, Jaspan T, Dineen RA. Diagnostic performance of axial T2-weighted MRI sequence for exclusion of brain tumour in paediatric patients with non-localizing symptoms. Br J Radiol 2024:tqae244. [PMID: 39673436 DOI: 10.1093/bjr/tqae244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2024] [Revised: 10/02/2024] [Accepted: 11/25/2024] [Indexed: 12/16/2024] Open
Abstract
OBJECTIVE To establish diagnostic performance of a single axial T2-weighted sequence for detection of brain tumours in children with non-localizing symptoms, compared to a standard MRI protocol. METHODS Retrospective analysis of children undergoing MRI brain imaging for suspected brain tumours with non-localizing symptoms over a 3-year period. Axial T2-weighted images were blindly reviewed by 2 experienced paediatric neuroradiologists. Primary analysis was calculation of diagnostic performance metrics for tumour identification using axial T2-weighted image only compared to the standard MRI protocol. RESULTS For 312 children undergoing MRI brain during the study period, sensitivity and specificity for brain tumour detection based on axial T2-weighted images in children with non-localizing symptoms were 1.000 (95% CIs 0.598, 1.000) and 0.998 (95% CI 0.990, 0.999), respectively. Based on T2-weighted images alone, 50 patients (16%) were flagged as needing recall for further imaging compared to 14 (4.5%) recalled after the standard protocol. CONCLUSIONS Axial T2-weighted images have high sensitivity and specificity for detection of brain tumours in children with non-localizing symptoms but are associated with increased imaging recall rates. Prospective evaluation of this approach to identify patients requiring more comprehensive imaging is warranted. ADVANCES IN KNOWLEDGE A truncated MRI protocol with single axial T2-weighted sequence has high diagnostic performance for brain tumour detection in children with non-localizing features. Radiologists can be reassured that a child with this presentation who is unable to complete the full MRI scan protocol is very unlikely to have a brain tumour missed provided an axial T2-weighted sequence is obtained.
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Affiliation(s)
- Amy C Gerrish
- Radiology, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, United Kingdom
| | - Luqman Malik
- Radiology, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, United Kingdom
| | - Charlotte Swain
- Radiology, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, United Kingdom
| | - Adam G Thomas
- Radiology, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, United Kingdom
| | - Timothy Jaspan
- Radiology, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, United Kingdom
| | - Rob A Dineen
- Radiology, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, United Kingdom
- Radiological Sciences, School of Medicine, University of Nottingham, Nottingham, NG7 2UH, United Kingdom
- Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, NG7 2UH, United Kingdom
- NIHR Nottingham Biomedical Research Centre, Nottingham, NG7 2UH, United Kingdom
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Che T, Kim S, Greene DJ, Heywood A, Ding J, Hershey T, Schlaggar BL, Black KJ, Wang L. Correlating clinical course with baseline subcortical shape in provisional tic disorder. CNS Spectr 2024; 29:652-664. [PMID: 39604269 PMCID: PMC11839322 DOI: 10.1017/s1092852924002190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2024]
Abstract
OBJECTIVE This study examined children at the onset of tic disorder (tics for less than 9 months: NT group), a population on which little research exists. Here, we investigate relationships between the baseline shape and volume of subcortical nuclei, diagnosis, and tic symptom outcomes. METHODS 187 children were assessed at baseline and a 12-month follow-up: 88 with NT, 60 tic-free healthy controls (HC), and 39 with chronic tic disorder/Tourette syndrome (TS), using T1-weighted MRI and total tic scores (TTS) from the Yale Global Tic Severity Scale to evaluate symptom change. Subcortical surface maps were generated using FreeSurfer-initialized large deformation diffeomorphic metric mapping. Linear regression models correlated baseline structural shapes with follow-up TTS while accounting for covariates, with relationships mapped onto structure surfaces. RESULTS We found that the NT group had a larger right hippocampus compared to HC. Surface maps illustrate distinct patterns of inward deformation in the putamen and outward deformation in the thalamus for NT compared to controls. We also found patterns of outward deformation in almost all studied structures when comparing the TS group to controls. The NT group also showed consistent outward deformation compared to TS in the caudate, accumbens, putamen, and thalamus. Subsequent analyses including clinical symptoms revealed that a larger pallidum and thalamus at baseline correlated with less improvement of tic symptoms at follow-up. CONCLUSION These observations constitute some of the first prognostic biomarkers for tic disorders and suggest that these subregional shape and volume differences may be associated with the outcome of tic disorders.
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Affiliation(s)
- Tiffanie Che
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Soyoung Kim
- Departments of Psychiatry and Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Deanna J. Greene
- Department of Cognitive Science, University of California San Diego, La Jolla, CA, USA
| | - Ashley Heywood
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jimin Ding
- Department of Mathematics and Statistics; Department of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Tamara Hershey
- Departments of Psychiatry, Neurology, Psychological and Brain Sciences and Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Bradley L. Schlaggar
- Kennedy Krieger Institute, Baltimore, MD, USA
- Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kevin J. Black
- Departments of Psychiatry, Neurology, Radiology and Neuroscience, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | - Lei Wang
- Department of Psychiatry and Behavioral Health, Ohio State University Wexner Medical Center, Columbus, OH, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Staab JH, Yoder AC, Brinton JT, Stence NV, Simonsen CE, Newman BF, Garcia KA, Browne LP. Child life specialists predict successful MRI scanning in unsedated children 4 to 12 years old. Pediatr Radiol 2024; 54:1919-1927. [PMID: 39292242 DOI: 10.1007/s00247-024-06040-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 08/20/2024] [Accepted: 08/21/2024] [Indexed: 09/19/2024]
Abstract
BACKGROUND It can be challenging for children to cooperate for a magnetic resonance imaging (MRI) exam. General anesthesia is often used to ensure a high-quality image. When determining the need for general anesthesia, many institutions use a simple age cutoff. Decisions on the necessity for anesthesia are often left to schedulers who lack training on determination of patient compliance. OBJECTIVE The study aimed to evaluate whether screening questions administered by certified child life specialists (CCLS) could successfully predict which children could complete an MRI without sedation. MATERIALS AND METHODS This is a retrospective, institutional review board approved study. Data was collected as part of a quality improvement program, where a CCLS screened 4- to 12-year-old children scheduled for MRI scanning using a questionnaire. Parent responses to the screening questions, CCLS's recommendation for scheduling the MRI awake, start and end time for the MRI scan, and scan success were recorded. A predictive model for the CCLS's recommendation was developed using the child's age, estimated scan length, scan difficulty, and the parent's responses to the screening questions. The primary outcome measure was a successfully completed MRI not requiring additional imaging under anesthesia. RESULTS Of the 403 screened children, 317 (79%) were recommended to attempt the MRI without anesthesia. The median age of participants was 7 (IQR 4-17) years. Overall, 309 of 317 (97.5%) participants, recommended by the CCLS for the program, met the primary outcome of successful MRI completion on their first attempt. The multivariable regression model which included clinical information about the child's age, estimated scan length, scan difficulty, and four of the six parent screening questions had excellent performance (area under the curve = 0.89). CONCLUSION Information collected by the CCLS via screening along with the child's age, the estimated scan length, and difficulty can help predict which children are likely to successfully complete a non-sedate MRI.
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Affiliation(s)
- Jennifer H Staab
- Children's Hospital Colorado, Aurora, CO, USA.
- Child Life Department, Children's Hospital Colorado, East 16th Ave, Aurora, CO, 1312380045, USA.
| | - Angela C Yoder
- University of Colorado Anschutz Medical Campus School of Medicine, Aurora, CO, USA
| | - John T Brinton
- University of Colorado Anschutz Medical Campus School of Medicine, Aurora, CO, USA
| | - Nicholas V Stence
- University of Colorado Anschutz Medical Campus School of Medicine, Aurora, CO, USA
| | | | | | | | - Lorna P Browne
- University of Colorado Anschutz Medical Campus School of Medicine, Aurora, CO, USA
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Corn E, Andringa-Seed R, Williams ME, Arroyave-Wessel M, Tarud R, Vezina G, Podolsky RH, Kapse K, Limperopoulos C, Berl MM, Cure C, Mulkey SB. Feasibility and success of a non-sedated brain MRI training protocol in 7-year-old children from rural and semi-rural Colombia. Pediatr Radiol 2024; 54:1513-1522. [PMID: 38970708 PMCID: PMC11482647 DOI: 10.1007/s00247-024-05964-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/20/2024] [Accepted: 05/25/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Brain magnetic resonance imaging (MRI) is a crucial tool for clinical evaluation of the brain and neuroscience research. Obtaining successful non-sedated MRI in children who live in resource-limited settings may be an additional challenge. OBJECTIVE To present a feasibility study of a novel, low-cost MRI training protocol used in a clinical research study in a rural/semi-rural region of Colombia and to examine neurodevelopmental factors associated with successful scans. MATERIALS AND METHODS Fifty-seven typically developing Colombian children underwent a training protocol and non-sedated brain MRI at age 7. Group training utilized a customized booklet, an MRI toy set, and a simple mock scanner. Children attended MRI visits in small groups of two to three. Resting-state functional and structural images were acquired on a 1.5-Tesla scanner with a protocol duration of 30-40 minutes. MRI success was defined as the completion of all sequences and no more than mild motion artifact. Associations between the Wechsler Preschool and Primary Scale of Intelligence (WPPSI), Movement Assessment Battery for Children (MABC), Behavioral Rating Inventory of Executive Function (BRIEF), Child Behavior Checklist (CBCL), and Adaptive Behavior Assessment System (ABAS) scores and MRI success were analyzed. RESULTS Mean (SD) age at first MRI attempt was 7.2 (0.2) years (median 7.2 years, interquartile range 7.1-7.3 years). Twenty-six (45.6%) participants were male. Fifty-one (89.5%) children were successful across two attempts; 44 (77.2%) were successful on their first attempt. Six (10.5%) were unsuccessful due to refusal or excessive motion. Age, sex, and scores across all neurodevelopmental assessments (MABC, TVIP, ABAS, BRIEF, CBCL, NIH Toolbox Flanker, NIH Toolbox Pattern Comparison, WPPSI) were not associated with likelihood of MRI success (P=0.18, 0.19, 0.38, 0.92, 0.84, 0.80, 1.00, 0.16, 0.75, 0.86, respectively). CONCLUSION This cohort of children from a rural/semi-rural region of Colombia demonstrated comparable MRI success rates to other published cohorts after completing a low-cost MRI familiarization training protocol suitable for low-resource settings. Achieving non-sedated MRI success in children in low-resource and international settings is important for the continuing diversification of pediatric research studies.
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Affiliation(s)
- Elizabeth Corn
- Zickler Family Prenatal Pediatrics Institute, Children's National Hospital, Washington DC, USA
| | - Regan Andringa-Seed
- Zickler Family Prenatal Pediatrics Institute, Children's National Hospital, Washington DC, USA
| | - Meagan E Williams
- Zickler Family Prenatal Pediatrics Institute, Children's National Hospital, Washington DC, USA
| | | | - Raul Tarud
- Sabbag Radiólogos, Barranquilla, Colombia
| | - Gilbert Vezina
- Division of Diagnostic Imaging and Radiology, Children's National Hospital, Washington DC, USA
| | - Robert H Podolsky
- Division of Biostatistics and Study Methodology, Children's National Hospital, Washington DC, USA
| | - Kushal Kapse
- Developing Brain Institute, Children's National Hospital, Washington DC, USA
| | - Catherine Limperopoulos
- Zickler Family Prenatal Pediatrics Institute, Children's National Hospital, Washington DC, USA
- Division of Diagnostic Imaging and Radiology, Children's National Hospital, Washington DC, USA
- Developing Brain Institute, Children's National Hospital, Washington DC, USA
- Department of Radiology, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | - Madison M Berl
- Division of Pediatric Neuropsychology, Children's National Hospital, Washington DC, USA
- Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington DC, USA
| | | | - Sarah B Mulkey
- Zickler Family Prenatal Pediatrics Institute, Children's National Hospital, Washington DC, USA.
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington DC, USA.
- Department of Neurology, The George Washington University School of Medicine and Health Sciences, Washington DC, USA.
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10
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Vreeland A, Reiss AL, Ross J, Foland-Ross LC. Alterations in Neural Activation During Facial Emotion Processing in Adolescent Male Participants With Klinefelter Syndrome. J Dev Behav Pediatr 2024; 45:e365-e371. [PMID: 38990140 PMCID: PMC11326988 DOI: 10.1097/dbp.0000000000001279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/18/2024] [Indexed: 07/12/2024]
Abstract
OBJECTIVE Klinefelter syndrome (KS) is the most common sex-chromosome aneuploidy (47,XXY), affecting 1 in 500 male participants. The phenotype of male participants with KS includes both physical features, such as tall stature and testicular insufficiency, and behavioral alterations, including difficulties in social functioning, anxiety, and depression. Studies examining underlying neural alterations associated with the behavioral phenotype, however, are sparse. We aimed to address this gap in knowledge using functional magnetic resonance imaging in conjunction with an emotion processing paradigm. METHOD Functional magnetic resonance imaging was conducted on 38 children and adolescents with KS ( Mage = 12.85, SD = 2.45) and 47 typical developing (control) boys ( Mage = 12.04, SD = 1.82) as they completed a facial emotion processing task. Group differences in activation occurring during the processing of angry versus neutral faces were examined while controlling for age. RESULTS The results indicated that relative to typically developing boys, boys with KS exhibited anomalous increases in activation of frontal, temporal, and occipital cortices. Within the KS group, secondary analyses indicated that greater activation in these regions was associated with more internalizing symptoms (e.g., anxiety, depression, withdrawn behaviors) and greater social impairments (e.g., social cognition, social communication, social motivation, social communication and interaction, functional communication). CONCLUSION The findings from this study indicate a possible neural correlation for difficulties in social and emotional function in KS and add to a growing body of research aimed at increasing our understanding of neural biomarkers in this condition. Future studies that examine the influence of testosterone-replacement therapy on these differences are warranted.
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Affiliation(s)
- Allison Vreeland
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Allan L. Reiss
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Judith Ross
- Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- DuPont Hospital for Children, Wilmington, Delaware, USA
| | - Lara C. Foland-Ross
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
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11
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Wang X, Fu K, Liu J, Xie H. Leveraging an efficient preparation method into magnetic resonance examinations of young children aged 3-6. Eur J Radiol 2024; 170:111256. [PMID: 38096742 DOI: 10.1016/j.ejrad.2023.111256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/15/2023] [Accepted: 12/05/2023] [Indexed: 01/16/2024]
Abstract
PURPOSE To evaluate the benefits of a multifaceted concept, ANMTE (Appropriate Number of children, appropriate learning Methods, appropriate adaptive Training, and appropriate Encouragement), proposed by our group, in improving the success rate, efficiency and image quality of Magnetic Resonance (MR) examinations for children from 3 to 6 years old. METHOD In this study, 150 participants were included from July 2019 to January 2023, including 50 non-sedated children in ANMTE group, 50 in the group with sedative, and 50 in the group with routine preparations. ANMTE refers to appropriate number of children, appropriate learning methods, appropriate adaptive training, and appropriate encouragement, developed by our group for MR examinations of children from 3 to 6 years old. Group differences in success rate, efficiency, and image quality were evaluated across the three groups using Kaplan-Meier, Log-rank and Chi-square test, respectively. RESULTS The rates of successful MR examinations were 44/50 (88 %), 45/50 (90 %), and 36/50 (72 %) for ANMTE group, the group with sedatives and the group with routine preparations, respectively (P = 0.03). Image quality of the 3 groups showed no significant group difference (P = 0.067). In terms of the median duration of MR examinations, ANMTE group was comparable to the group with sedative (both were about 10.0 min), but better than the group with routine preparations (16.5 min) (P = 0.024). CONCLUSION We demonstrated the feasibility of our comprehensive nursing method ANMTE in MR examinations of young children, similar to the group with sedative at the success rate and image quality as well as the durations of MR examinations. ANMTE has not only better efficiency but also higher safety as it does not require sedative, which could be promising in clinical routine MR examinations for young children aged 3-6 years old.
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Affiliation(s)
- Xueqin Wang
- Department of Radiology, Daping Hospital, Army Medical University (Army Medical Center of PLA), Chongqing, China.
| | - Kun Fu
- Department of Radiology, Daping Hospital, Army Medical University (Army Medical Center of PLA), Chongqing, China.
| | - Junling Liu
- Department of Radiology, Daping Hospital, Army Medical University (Army Medical Center of PLA), Chongqing, China.
| | - Huan Xie
- Department of Radiology, Daping Hospital, Army Medical University (Army Medical Center of PLA), Chongqing, China.
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12
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Geuens S, Lemiere J, Nijs J, Treunen M, Aertsen M, Toelen J, Pauwels G, Sauer K, Potoms M, Van Cauter S, Wouters L, Hohlbaum K, Sjölinder M, Ståhl O, Buyse G, Demaerel P, Weyn B. Testing a Home Solution for Preparing Young Children for an Awake MRI: A Promising Smartphone Application. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1866. [PMID: 38136068 PMCID: PMC10742285 DOI: 10.3390/children10121866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/11/2023] [Accepted: 11/27/2023] [Indexed: 12/24/2023]
Abstract
Thanks to its non-invasive nature and high-resolution imaging capabilities, magnetic resonance imaging (MRI) is a valuable diagnostic tool for pediatric patients. However, the fear and anxiety experienced by young children during MRI scans often result in suboptimal image quality and the need for sedation/anesthesia. This study aimed to evaluate the effect of a smartphone application called COSMO@home to prepare children for MRI scans to reduce the need for sedation or general anesthesia. The COSMO@home app was developed incorporating mini-games and an engaging storyline to prepare children for learning goals related to the MRI procedure. A multicenter study was conducted involving four hospitals in Belgium. Eligible children aged 4-10 years were prepared with the COSMO@home app at home. Baseline, pre-scan, and post-scan questionnaires measured anxiety evolution in two age groups (4-6 years and 7-10 years). Eighty-two children participated in the study, with 95% obtaining high-quality MRI images. The app was well-received by children and parents, with minimal technical difficulties reported. In the 4-6-year-old group (N = 33), there was a significant difference between baseline and pre-scan parent-reported anxiety scores, indicating an increase in anxiety levels prior to the scan. In the 7-10-year-old group (N = 49), no significant differences were observed between baseline and pre-scan parent-reported anxiety scores. Overall, the COSMO@home app proved to be useful in preparing children for MRI scans, with high satisfaction rates and successful image outcomes across different hospitals. The app, combined with minimal face-to-face guidance on the day of the scan, showed the potential to replace or assist traditional face-to-face training methods. This innovative approach has the potential to reduce the need for sedation or general anesthesia during pediatric MRI scans and its associated risks and improve patient experience.
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Affiliation(s)
- Sam Geuens
- University Hospitals Leuven, 3000 Leuven, Belgium (J.N.); (M.T.)
| | - Jurgen Lemiere
- University Hospitals Leuven, 3000 Leuven, Belgium (J.N.); (M.T.)
| | - Jessica Nijs
- University Hospitals Leuven, 3000 Leuven, Belgium (J.N.); (M.T.)
| | - Marlies Treunen
- University Hospitals Leuven, 3000 Leuven, Belgium (J.N.); (M.T.)
| | - Michael Aertsen
- University Hospitals Leuven, 3000 Leuven, Belgium (J.N.); (M.T.)
| | - Jaan Toelen
- University Hospitals Leuven, 3000 Leuven, Belgium (J.N.); (M.T.)
| | | | | | | | - Sofie Van Cauter
- Department Medical Imaging, Ziekenhuis Oost-Limburg, 3600 Genk, Belgium
- Centre for Translational Psychological Research TRACE, Ziekenhuis Oost-Limburg, 3600 Genk, Belgium
| | - Leen Wouters
- Centre for Translational Psychological Research TRACE, Ziekenhuis Oost-Limburg, 3600 Genk, Belgium
- Ziekenhuis Oost-Limburg, 3600 Genk, Belgium
| | | | - Marie Sjölinder
- Research Institutes of Sweden (RISE), 103 33 Stockholm, Sweden; (M.S.)
| | - Olov Ståhl
- Research Institutes of Sweden (RISE), 103 33 Stockholm, Sweden; (M.S.)
| | - Gunnar Buyse
- University Hospitals Leuven, 3000 Leuven, Belgium (J.N.); (M.T.)
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13
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Chen JV, Zapala MA, Zhou A, Vu N, Meyer L, Smith MD, Kelleher C, Glenn OA, Courtier J, Li Y. Factors and Labor Cost Savings Associated with Successful Pediatric Imaging without Anesthesia: a Single-Institution Study. Acad Radiol 2023; 30:1979-1988. [PMID: 36641347 DOI: 10.1016/j.acra.2022.12.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/13/2022] [Accepted: 12/25/2022] [Indexed: 01/15/2023]
Abstract
RATIONALE AND OBJECTIVES In pediatric imaging, sedation is often necessary to obtain diagnostic quality imaging. We aim to quantify patient and imaging-specific factors associated with successful pediatric scans without anesthesia and to evaluate labor cost savings associated with our institutional Scan Without Anesthesia Program (SWAP). MATERIALS AND METHODS Patients who participated in SWAP between 2019-2022 were identified. Chart review was conducted to obtain sociodemographic and clinical information. Radiology database was used to obtain scan duration, modality/body part of examination, and administration of contrast. Mann-Whitney U and Chi-Square tests were used for univariate analysis of factors associated with success. Multivariate logistic regression was used to evaluate independent contributions to success. Associated hospital labor cost savings were estimated using salary information obtained through publicly available resources. RESULTS Of 731 patients, 698 had successful and 33 had unsuccessful scans (95% success rate). In univariate analysis, older age, female sex, absence of developmental delay, and administration of contrast were significantly associated with successful scans. Multivariate analyses revealed that older age, female sex, and absence of developmental delay were significant independent factors lending toward success. Imaging-related factors were not associated with outcome in multivariate analysis. Estimated labor cost savings were $139,367.80 per year for the medical center. CONCLUSION SWAP had an overall success rate of 95%. Older age, absence of developmental delay, and female sex were independently significantly associated with successful outcome. Cost analysis reveals substantial labor cost savings to the institution compared with imaging under anesthesia.
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Affiliation(s)
- Joshua Vic Chen
- School of Medicine, University of California, San Francisco, CA
| | - Matthew A Zapala
- Department of Radiology and Biomedical Imaging, University of California, Neuroradiology Section, 505 Parnassus Avenue, M-391, San Francisco, California, 94143-0628
| | - Alice Zhou
- Department of Radiology and Biomedical Imaging, University of California, Neuroradiology Section, 505 Parnassus Avenue, M-391, San Francisco, California, 94143-0628
| | - Nola Vu
- School of Public Health, University of California, Berkeley, CA
| | - Lauren Meyer
- Department of Radiology and Biomedical Imaging, University of California, Neuroradiology Section, 505 Parnassus Avenue, M-391, San Francisco, California, 94143-0628
| | - Mikaela Demartini Smith
- Department of Radiology and Biomedical Imaging, University of California, Neuroradiology Section, 505 Parnassus Avenue, M-391, San Francisco, California, 94143-0628
| | - Chloe Kelleher
- Department of Radiology and Biomedical Imaging, University of California, Neuroradiology Section, 505 Parnassus Avenue, M-391, San Francisco, California, 94143-0628
| | - Orit A Glenn
- Department of Radiology and Biomedical Imaging, University of California, Neuroradiology Section, 505 Parnassus Avenue, M-391, San Francisco, California, 94143-0628
| | - Jesse Courtier
- Department of Radiology and Biomedical Imaging, University of California, Neuroradiology Section, 505 Parnassus Avenue, M-391, San Francisco, California, 94143-0628
| | - Yi Li
- Department of Radiology and Biomedical Imaging, University of California, Neuroradiology Section, 505 Parnassus Avenue, M-391, San Francisco, California, 94143-0628.
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14
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Fletcher S, Lardner D, Bagshawe M, Carsolio L, Sherriff M, Smith C, Lebel C. Effectiveness of training before unsedated MRI scans in young children: a randomized control trial. Pediatr Radiol 2023; 53:1476-1484. [PMID: 37010547 DOI: 10.1007/s00247-023-05647-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 02/17/2023] [Accepted: 03/10/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Young children requiring clinical magnetic resonance imaging (MRI) may be given general anesthesia. General anesthesia has potential side effects, is costly, and introduces logistical challenges. Thus, methods that allow children to undergo awake MRI scans are desirable. OBJECTIVES To compare the effectiveness of mock scanner training with a child life specialist, play-based training with a child life specialist, and home book and video preparation by parents to allow non-sedated clinical MRI scanning in children aged 3-7 years. MATERIALS AND METHODS Children (3-7 years, n=122) undergoing clinical MRI scans at the Alberta Children's Hospital were invited to participate and randomized to one of three groups: home-based preparation materials, training with a child life specialist (no mock MRI), or training in a mock MRI with a child life specialist. Training occurred a few days prior to their MRI. Self- and parent-reported functioning (PedsQL VAS) were assessed pre/post-training (for the two training groups) and pre/post-MRI. Scan success was determined by a pediatric radiologist. RESULTS Overall, 91% (111/122) of children successfully completed an awake MRI. There were no significant differences between the mock scanner (89%, 32/36), child life (88%, 34/39), and at-home (96%, 45/47) groups (P=0.34). Total functioning scores were similar across groups; however, the mock scanner group had significantly lower self-reported fear (F=3.2, P=0.04), parent-reported sadness (F=3.3, P=0.04), and worry (F=3.5, P=0.03) prior to MRI. Children with unsuccessful scans were younger (4.5 vs. 5.7 years, P<0.001). CONCLUSIONS Most young children can tolerate awake MRI scans and do not need to be routinely anesthetized. All preparation methods tested, including at-home materials, were effective.
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Affiliation(s)
- Sarah Fletcher
- Faculty of Medicine, University of British Columbia, T3B6A8, Vancouver, Canada
| | - David Lardner
- Alberta Children's Hospital, T3B6A8, Calgary, Canada
| | | | - Lisa Carsolio
- Alberta Children's Hospital, T3B6A8, Calgary, Canada
| | | | - Cathy Smith
- Alberta Children's Hospital, T3B6A8, Calgary, Canada
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15
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Abramson ZR, Nagaraj UD, Lai LM, Liu CCY, Schroeder JW, Khanna PC, Chuang NA, Strauss S, Gomez G, Clarke R, Singh S, Choudhri AF, Whitehead MT. Imaging of pediatric head and neck tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee/ASPNR White Paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e30151. [PMID: 36546312 PMCID: PMC10644272 DOI: 10.1002/pbc.30151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Zachary R Abramson
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Usha D Nagaraj
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Lillian M Lai
- Department of Radiology, University of Iowa Hospitals and Clinics and Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Christopher Cheng-Yu Liu
- Department of Otolaryngology, Pediatric Otolaryngology Division, UT Southwestern Medical Center and Children's Health Dallas, Dallas, Texas, USA
| | - Jason W Schroeder
- Department of Radiology, Children's National Hospital, Washington, District of Columbia, USA
| | - Paritosh C Khanna
- Department of Radiology, Rady Children's Hospital, University of California, San Diego, California, USA
| | - Nathaniel A Chuang
- Department of Radiology, Rady Children's Hospital, University of California, San Diego, California, USA
| | - Sara Strauss
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Gabriel Gomez
- University of Southern California, Keck School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Rebekah Clarke
- Department of Radiology, University of Texas Southwestern Medical Center and Children's Health Dallas, Dallas, Texas, USA
| | - Sumit Singh
- Department of Radiology, University of Texas Southwestern Medical Center and Children's Health Dallas, Dallas, Texas, USA
| | - Asim F Choudhri
- Le Bonheur Neuroscience Institute, Le Bonheur Children's Hospital, Departments of Radiology, Ophthalmology, and Neurosurgery, University of Tennessee Health Science Center (UTHSC), Memphis, Tennessee, USA
| | - Matthew T Whitehead
- Department of Radiology, Children's National Hospital, Washington, District of Columbia, USA
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16
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Saggar M, Bruno JL, Hall SS. Brief intensive social gaze training reorganizes functional brain connectivity in boys with fragile X syndrome. Cereb Cortex 2023; 33:5218-5227. [PMID: 36376964 PMCID: PMC10151883 DOI: 10.1093/cercor/bhac411] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
Boys with fragile X syndrome (FXS), the leading known genetic cause of autism spectrum disorder (ASD), demonstrate significant impairments in social gaze and associated weaknesses in communication, social interaction, and other areas of adaptive functioning. Little is known, however, concerning the impact of behavioral treatments for these behaviors on functional brain connectivity in this population. As part of a larger study, boys with FXS (mean age 13.23 ± 2.31 years) and comparison boys with ASD (mean age 12.15 ± 2.76 years) received resting-state functional magnetic resonance imaging scans prior to and following social gaze training administered by a trained behavior therapist in our laboratory. Network-agnostic connectome-based predictive modeling of pretreatment resting-state functional connectivity data revealed a set of positive (FXS > ASD) and negative (FXS < ASD) edges that differentiated the groups significantly and consistently across all folds of cross-validation. Following administration of the brief training, the FXS and ASD groups demonstrated reorganization of connectivity differences. The divergence in the spatial pattern of reorganization response, based on functional connectivity differences pretreatment, suggests a unique pattern of response to treatment in the FXS and ASD groups. These results provide further support for implementing targeted behavioral treatments to ameliorate syndrome-specific behavioral features in FXS.
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Affiliation(s)
- Manish Saggar
- Division of Interdisciplinary Brain Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94304, United States
| | - Jennifer L Bruno
- Division of Interdisciplinary Brain Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94304, United States
| | - Scott S Hall
- Division of Interdisciplinary Brain Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94304, United States
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17
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Weiler-Wichtl LJ, Fries J, Fohn-Erhold V, Schwarzinger A, Holzer AE, Pletschko T, Furtner-Srajer J, Prayer D, Bär P, Slavc I, Peyrl A, Azizi A, Hansl R, Leiss U. Initial Evidence for Positive Effects of a Psychological Preparation Program for MRI "iMReady" in Children with Neurofibromatosis Type I and Brain Tumors-How to Meet the Patients' Needs Best. J Clin Med 2023; 12:jcm12051902. [PMID: 36902689 PMCID: PMC10003409 DOI: 10.3390/jcm12051902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/22/2023] [Accepted: 02/25/2023] [Indexed: 03/08/2023] Open
Abstract
To provide an effective alternative to sedation during MRI examinations in pediatric cancer and NF1 patients, the aims of the present study were to (1) exploratively evaluate a behavioral MRI training program, to (2) investigate potential moderators, as well as to (3) assess the patients' well-being over the course of the intervention. A total of n = 87 patients of the neuro-oncology unit (mean age: 6.83 years) underwent a two-step MRI preparation program, including training inside the scanner, and were recorded using a process-oriented screening. In addition to the retrospective analysis of all data, a subset of 17 patients were also analyzed prospectively. Overall, 80% of the children receiving MRI preparation underwent the MRI scan without sedation, making the success rate almost five times higher than that of a group of 18 children that opted out of the training program. Memory, attentional difficulties, and hyperactivity were significant neuropsychological moderators for successful scanning. The training was associated with favorable psychological well-being. These findings suggest that our MRI preparation could present an alternative to sedation of young patients undergoing MRI examinations as well as a promising tool for improving patients' treatment-related well-being.
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Affiliation(s)
- Liesa Josephine Weiler-Wichtl
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria
- Correspondence: ; Tel.: +43-1-40400-34262
| | - Jonathan Fries
- Department of Developmental and Educational Psychology, Faculty of Psychology, University of Vienna, 1010 Vienna, Austria
| | - Verena Fohn-Erhold
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Agathe Schwarzinger
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Angelika Elisabeth Holzer
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria
- Interdisciplinary Follow-Up Clinic for Childhood Cancer Survivors (IONA), Österreichische Gesundheitskasse (ÖGK), 1060 Vienna, Austria
| | - Thomas Pletschko
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Julia Furtner-Srajer
- Department of Radiology and Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Daniela Prayer
- Department of Radiology and Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Paul Bär
- Department of Radiology and Nuclear Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Irene Slavc
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Andreas Peyrl
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Amedeo Azizi
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Rita Hansl
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Ulrike Leiss
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria
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18
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Suzuki A, Yamaguchi R, Kim L, Kawahara T, Ishii-Takahashi A. Effectiveness of mock scanners and preparation programs for successful magnetic resonance imaging: a systematic review and meta-analysis. Pediatr Radiol 2023; 53:142-158. [PMID: 35699762 DOI: 10.1007/s00247-022-05394-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 03/31/2022] [Accepted: 05/03/2022] [Indexed: 01/24/2023]
Abstract
This review aimed to summarise the effectiveness of preparation programs for magnetic resonance imaging (MRI) in children using mock scanners and the success rates by systematically reviewing the current literature. We initially identified 67 articles using the search terms "MRI," "mock" and "child" on online databases. All studies involving a preparation programme for MRI on children ages 18 years or younger, healthy children and those with medical diagnoses were included. The authors extracted data on study design, participant data, details of the MRI protocol and the total numbers of patients who underwent preparation programs and were scanned while awake, without sedation or general anesthesia. Twenty-three studies were included in this review. Preparation programs included in-home and hospital/research facility components; these consisted of a mock scanner, explanatory booklets, recorded MRI scan sounds and other educational materials. The success rate of MRI after the preparation programme reported in each study ranged from 40% to 100%. When all participants from studies that specifically assessed the efficacy of preparation programs were combined, participants who underwent a preparation programme (n = 196) were more likely to complete a successful MRI than those who did not undergo a preparation programme (n = 263) (odds ratio [OR] = 1.98). Our results suggest that preparation programs may help reduce the risk of children failing MRI scans.
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Affiliation(s)
- Akane Suzuki
- Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.,Department of Child Psychiatry, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan
| | - Rio Yamaguchi
- Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Leesa Kim
- Department of Child Psychiatry, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan.,Division of Clinical Psychology, Graduate School of Education, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Takuya Kawahara
- Clinical Research Promotion Center, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Ayaka Ishii-Takahashi
- Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan. .,Department of Child Psychiatry, The University of Tokyo Hospital, Bunkyo-ku, Tokyo, Japan. .,Department of Developmental Disorders, National Center of Neurology and Psychiatry, National Institute of Mental Health, Kodaira, Tokyo, Japan.
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19
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Castro MC, Ramos I, Carvalho IP. The Influence of Patient-Centered Communication on Children's Anxiety and Use of Anesthesia for MR. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:414. [PMID: 36612736 PMCID: PMC9819401 DOI: 10.3390/ijerph20010414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/23/2022] [Accepted: 12/24/2022] [Indexed: 06/17/2023]
Abstract
Background: The aim of this study was to inspect the influence of patient-centered communication (PCC) with 4- to 10-year-old children on the use of anesthesia for magnetic resonance imaging exams (MRs). Methods: A total of thirty children received the PCC and pre-simulated the exam with an MR toy. Another 30 children received routine information about the MR and pre-simulated the exam with the toy. Anesthesia use in these two groups was additionally compared with a previously existing group of children (n = 30) who had received only routine information about the exam (CG). Children’s anxiety was assessed with a self-report question plus heartbeat frequency. Children’s satisfaction was assessed through several questions. The analyses were based on group comparisons and regression. Results: A total of two children (7%) in the PCC + simulation group used sedation compared with 14 (47%) in the simulation group and 21 (70%) in the CG. Differences between the PCC + simulation and the other two groups were significant (p < 0.001), although not between the simulation and the CG. The decrease in anxiety was significantly greater (self-reported p < 0.001; heart rate p < 0.05) and satisfaction was higher (p = 0.001) in the PCC + simulation, when compared with the simulation group. Reduced anxiety was associated with less anesthesia use (OR 1.39; CI 1.07−1.79; p = 0.013). Conclusions: PCC + simulation was more effective than simulation and routine practice in decreasing children’s anxiety, increasing satisfaction, and reducing the use of anesthesia for MRs.
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Affiliation(s)
- M. Conceição Castro
- Department of Radiology, Centro Hospitalar Universitário de São João–Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Isabel Ramos
- Faculty of Medicine, University of Porto-Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Irene Palmares Carvalho
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto-Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
- CINTESIS@RISE, Faculty of Medicine, University of Porto-Alameda Professor Hernâni Monteiro, 4200-319 Porto, Portugal
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20
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Vyas KS, Suchyta MA, Hunt CH, Gibreel W, Mardini S. Black Bone MRI for Virtual Surgical Planning in Craniomaxillofacial Surgery. Semin Plast Surg 2022; 36:192-198. [PMID: 36506277 PMCID: PMC9729059 DOI: 10.1055/s-0042-1756451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Advances in computer-aided design and computer-aided manufacturing software have improved translational applications of virtual surgical planning (VSP) in craniomaxillofacial surgery, allowing for precise and accurate fabrication of cutting guides, stereolithographic models, and custom implants. High-resolution computed tomography (CT) imaging has traditionally been the gold standard imaging modality for VSP in craniomaxillofacial surgery but delivers ionizing radiation. Black bone magnetic resonance imaging (MRI) reduces the risks related to radiation exposure and has comparable functionality when compared with CT for VSP. Our group has studied the accuracy of utilizing black bone MRI in planning and executing several types of craniofacial surgeries, including cranial vault remodeling, maxillary advancement, and mandibular reconstruction using fibular bone. Here, we review clinical applications of black bone MRI pertaining to VSP and three-dimensional (3D)-printed guide creation for craniomaxillofacial surgery. Herein, we review the existing literature and our institutional experience comparing black bone MRI and CT in VSP-generated 3D model creation in cadaveric craniofacial surgeries including cranial vault reconstruction, maxillary advancement, and mandibular reconstruction with fibular free flap. Cadaver studies have demonstrated the ability to perform VSP and execute the procedure based on black bone MRI data and achieve outcomes similar to CT when performed for cranial vault reshaping, maxillary advancement, and mandibular reconstruction with free fibula. Limitations of the technology include increased time and costs of the MRI compared with CT and the possible need for general anesthesia or sedation in the pediatric population. VSP and 3D surgical guide creation can be performed using black bone MRI with comparable accuracy to high-resolution CT scans in a wide variety of craniofacial reconstructions. Successful segmentation, VSP, and 3D printing of accurate guides from black bone MRI demonstrate potential to change the preoperative planning standard of care. Black bone MRI also reduces exposure to ionizing radiation, which is of particular concern for the pediatric population or patients undergoing multiple scans.
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Affiliation(s)
- Krishna S. Vyas
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Marissa A. Suchyta
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | | | - Waleed Gibreel
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Samir Mardini
- Division of Plastic Surgery, Department of Surgery, Mayo Clinic, Rochester, Minnesota,Department of Radiology, Mayo Clinic, Rochester, Minnesota,Essam and Dalal Obaid Center for Reconstructive Transplant Surgery, Mayo Clinic, Rochester, Minnesota,Address for correspondence Samir Mardini, MD Division of Plastic Surgery, Department of Surgery, Essam and Dalal Obaid Center for Reconstructive Transplant SurgeryMayo Clinic, MA12-44W, 200 First Street SouthwestRochester, MN 55905
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21
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Garcini LM, Arredondo MM, Berry O, Church JA, Fryberg S, Thomason ME, McLaughlin KA. Increasing diversity in developmental cognitive neuroscience: A roadmap for increasing representation in pediatric neuroimaging research. Dev Cogn Neurosci 2022; 58:101167. [PMID: 36335807 PMCID: PMC9638728 DOI: 10.1016/j.dcn.2022.101167] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/18/2022] [Accepted: 10/26/2022] [Indexed: 01/13/2023] Open
Abstract
Understanding of human brain development has advanced rapidly as the field of developmental cognitive neuroscience (DCN) has matured into an established scientific discipline. Despite substantial progress, DCN lags behind other related disciplines in terms of diverse representation, standardized reporting requirements for socio-demographic characteristics of participants in pediatric neuroimaging studies, and use of intentional sampling strategies to more accurately represent the socio-demographic, ethnic, and racial composition of the populations from which participants are sampled. Additional efforts are needed to shift DCN towards a more inclusive field that facilitates the study of individual differences across a variety of cultural and contextual experiences. In this commentary, we outline and discuss barriers within our current scientific practice (e.g., research methods) and beliefs (i.e., what constitutes good science, good scientists, and good research questions) that contribute to under-representation and limited diversity within pediatric neuroimaging studies and propose strategies to overcome those barriers. We discuss strategies to address barriers at intrapersonal, interpersonal, community, systemic, and structural levels. Highlighting strength-based models of inclusion and recognition of the value of diversity in DCN research, along with acknowledgement of the support needed to diversify the field is critical for advancing understanding of neurodevelopment and reducing health inequities.
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Affiliation(s)
- Luz M Garcini
- Department of Psychological Sciences, Rice University, United States
| | - Maria M Arredondo
- Department of Human Development and Family Sciences, The University of Texas at Austin, United States.
| | - Obianuju Berry
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, United States
| | - Jessica A Church
- Department of Psychology, The University of Texas at Austin, United States
| | | | - Moriah E Thomason
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, United States
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22
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Davis BR, Garza A, Church JA. Key considerations for child and adolescent MRI data collection. FRONTIERS IN NEUROIMAGING 2022; 1:981947. [PMID: 36312216 PMCID: PMC9615104 DOI: 10.3389/fnimg.2022.981947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/16/2022] [Indexed: 11/15/2022]
Abstract
Cognitive neuroimaging researchers' ability to infer accurate statistical conclusions from neuroimaging depends greatly on the quality of the data analyzed. This need for quality control is never more evident than when conducting neuroimaging studies with children and adolescents. Developmental neuroimaging requires patience, flexibility, adaptability, extra time, and effort. It also provides us a unique, non-invasive way to understand the development of cognitive processes, individual differences, and the changing relations between brain and behavior over the lifespan. In this discussion, we focus on collecting magnetic resonance imaging (MRI) data, as it is one of the more complex protocols used with children and youth. Through our extensive experience collecting MRI datasets with children and families, as well as a review of current best practices, we will cover three main topics to help neuroimaging researchers collect high-quality datasets. First, we review key recruitment and retention techniques, and note the importance for consistency and inclusion across groups. Second, we discuss ways to reduce scan anxiety for families and ways to increase scan success by describing the pre-screening process, use of a scanner simulator, and the need to focus on participant and family comfort. Finally, we outline several important design considerations in developmental neuroimaging such as asking a developmentally appropriate question, minimizing data loss, and the applicability of public datasets. Altogether, we hope this article serves as a useful tool for those wishing to enter or learn more about developmental cognitive neuroscience.
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Affiliation(s)
| | | | - Jessica A. Church
- Department of Psychology, The University of Texas at Austin, Austin, TX, United States
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23
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Bray L, Booth L, Gray V, Maden M, Thompson J, Saron H. Interventions and methods to prepare, educate or familiarise children and young people for radiological procedures: a scoping review. Insights Imaging 2022; 13:146. [PMID: 36064983 PMCID: PMC9445139 DOI: 10.1186/s13244-022-01278-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/24/2022] [Indexed: 11/11/2022] Open
Abstract
Children attending hospital for radiological procedures can experience uncertainty, anxiety and distress; this can result in sub-optimal experiences for children, poor scan quality and the need for radiological procedures to be rescheduled or sedation to be used. The preparation and education of children before clinical procedures has been shown to have a positive influence on procedural outcomes. This scoping review aimed to locate and examine the evidence relating to non-invasive interventions and methods to prepare, educate and familiarise children for radiological procedures within a healthcare setting. A comprehensive search strategy identified 36 articles. A narrative synthesis approach was adopted to make sense of the key findings. Studies investigated a range of radiological procedures (MRI, plain radiographs, CT, fluoroscopy and Micturating cystourethrogram) using a wide range of interventions (smartphone applications, storybooks, videos, mock scanners) which varied by method, mode of delivery and target audience. The outcomes used to evaluate the value and impact of the interventions are wide, varied and inconsistently applied making it difficult to judge which interventions offer the optimal impact on scan quality, scan completion and children's experiences. This review highlights that there is a need to further understand which specific elements of the non-invasive interventions 'work best' for children. There is a need for consistency on the outcomes measured and for these measures to include child-centred outcomes alongside scan quality and length of radiological procedure.
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Affiliation(s)
- Lucy Bray
- Faculty of Health, Social Care and Medicine, Child Health Literacy, Edge Hill University, Ormskirk, UK.
| | - Lisa Booth
- Institute of Health and Wellbeing, University of Cumbria, Cumbria, UK
| | - Victoria Gray
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | | | - Jill Thompson
- Division of Nursing and Midwifery, Health Sciences School, The University of Sheffield, Sheffield, UK
| | - Holly Saron
- Faculty of Health, Social Care and Medicine, Child Health Literacy, Edge Hill University, Ormskirk, UK
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24
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Reiss AL, Jo B, Arbelaez AM, Tsalikian E, Buckingham B, Weinzimer SA, Fox LA, Cato A, White NH, Tansey M, Aye T, Tamborlane W, Englert K, Lum J, Mazaika P, Foland-Ross L, Marzelli M, Mauras N. A Pilot randomized trial to examine effects of a hybrid closed-loop insulin delivery system on neurodevelopmental and cognitive outcomes in adolescents with type 1 diabetes. Nat Commun 2022; 13:4940. [PMID: 36042217 PMCID: PMC9427757 DOI: 10.1038/s41467-022-32289-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 07/26/2022] [Indexed: 12/23/2022] Open
Abstract
Type 1 diabetes (T1D) is associated with lower scores on tests of cognitive and neuropsychological function and alterations in brain structure and function in children. This proof-of-concept pilot study (ClinicalTrials.gov Identifier NCT03428932) examined whether MRI-derived indices of brain development and function and standardized IQ scores in adolescents with T1D could be improved with better diabetes control using a hybrid closed-loop insulin delivery system. Eligibility criteria for participation in the study included age between 14 and 17 years and a diagnosis of T1D before 8 years of age. Randomization to either a hybrid closed-loop or standard diabetes care group was performed after pre-qualification, consent, enrollment, and collection of medical background information. Of 46 participants assessed for eligibility, 44 met criteria and were randomized. Two randomized participants failed to complete baseline assessments and were excluded from final analyses. Participant data were collected across five academic medical centers in the United States. Research staff scoring the cognitive assessments as well as those processing imaging data were blinded to group status though participants and their families were not. Forty-two adolescents, 21 per group, underwent cognitive assessment and multi-modal brain imaging before and after the six month study duration. HbA1c and sensor glucose downloads were obtained quarterly. Primary outcomes included metrics of gray matter (total and regional volumes, cortical surface area and thickness), white matter volume, and fractional anisotropy. Estimated power to detect the predicted treatment effect was 0.83 with two-tailed, α = 0.05. Adolescents in the hybrid closed-loop group showed significantly greater improvement in several primary outcomes indicative of neurotypical development during adolescence compared to the standard care group including cortical surface area, regional gray volumes, and fractional anisotropy. The two groups were not significantly different on total gray and white matter volumes or cortical thickness. The hybrid closed loop group also showed higher Perceptual Reasoning Index IQ scores and functional brain activity more indicative of neurotypical development relative to the standard care group (both secondary outcomes). No adverse effects associated with study participation were observed. These results suggest that alterations to the developing brain in T1D might be preventable or reversible with rigorous glucose control. Long term research in this area is needed.
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Affiliation(s)
- Allan L Reiss
- Center for Interdisciplinary Brain Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.
- Department of Radiology, Stanford University, Stanford, CA, USA.
- Department of Pediatrics, Stanford University, Stanford, CA, USA.
| | - Booil Jo
- Center for Interdisciplinary Brain Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Ana Maria Arbelaez
- Divisions of Endocrinology & Diabetes, at Washington University in St, Louis, St, Louis, MO, USA
| | - Eva Tsalikian
- Stead Family Department of Pediatrics, Endocrinology and Diabetes, University of Iowa, Iowa City, IA, USA
| | - Bruce Buckingham
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | | | - Larry A Fox
- Division of Endocrinology, Diabetes & Metabolism, Nemours Children's Health, Jacksonville, FL, USA
| | - Allison Cato
- Division of Neurology, Nemours Children's Health, Jacksonville, FL, USA
| | - Neil H White
- Divisions of Endocrinology & Diabetes, at Washington University in St, Louis, St, Louis, MO, USA
| | - Michael Tansey
- Stead Family Department of Pediatrics, Endocrinology and Diabetes, University of Iowa, Iowa City, IA, USA
| | - Tandy Aye
- Department of Pediatrics, Stanford University, Stanford, CA, USA
| | | | - Kimberly Englert
- Division of Endocrinology, Diabetes & Metabolism, Nemours Children's Health, Jacksonville, FL, USA
| | - John Lum
- Jaeb Center for Health Research, Tampa, FL, USA
| | - Paul Mazaika
- Center for Interdisciplinary Brain Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Lara Foland-Ross
- Center for Interdisciplinary Brain Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Matthew Marzelli
- Center for Interdisciplinary Brain Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Nelly Mauras
- Division of Endocrinology, Diabetes & Metabolism, Nemours Children's Health, Jacksonville, FL, USA
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25
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Schneider DT, Balg J, Bernbeck B, Ellerkmann R, Klein M, Leutner A, Lindel P, Manns G, Mause U, Preziosi M, Schilling A, Schnittfeld S, Seyfert A, Winkelmann A, Rohde S. Magnetresonanztomographie-Untersuchung von Kindern in einem audiovisuell gestalteten Kinder-Magnetresonanztomographen. Monatsschr Kinderheilkd 2022. [DOI: 10.1007/s00112-022-01541-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Pulli EP, Silver E, Kumpulainen V, Copeland A, Merisaari H, Saunavaara J, Parkkola R, Lähdesmäki T, Saukko E, Nolvi S, Kataja EL, Korja R, Karlsson L, Karlsson H, Tuulari JJ. Feasibility of FreeSurfer Processing for T1-Weighted Brain Images of 5-Year-Olds: Semiautomated Protocol of FinnBrain Neuroimaging Lab. Front Neurosci 2022; 16:874062. [PMID: 35585923 PMCID: PMC9108497 DOI: 10.3389/fnins.2022.874062] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 04/12/2022] [Indexed: 02/03/2023] Open
Abstract
Pediatric neuroimaging is a quickly developing field that still faces important methodological challenges. Pediatric images usually have more motion artifact than adult images. The artifact can cause visible errors in brain segmentation, and one way to address it is to manually edit the segmented images. Variability in editing and quality control protocols may complicate comparisons between studies. In this article, we describe in detail the semiautomated segmentation and quality control protocol of structural brain images that was used in FinnBrain Birth Cohort Study and relies on the well-established FreeSurfer v6.0 and ENIGMA (Enhancing Neuro Imaging Genetics through Meta Analysis) consortium tools. The participants were typically developing 5-year-olds [n = 134, 5.34 (SD 0.06) years, 62 girls]. Following a dichotomous quality rating scale for inclusion and exclusion of images, we explored the quality on a region of interest level to exclude all regions with major segmentation errors. The effects of manual edits on cortical thickness values were relatively minor: less than 2% in all regions. Supplementary Material cover registration and additional edit options in FreeSurfer and comparison to the computational anatomy toolbox (CAT12). Overall, we conclude that despite minor imperfections FreeSurfer can be reliably used to segment cortical metrics from T1-weighted images of 5-year-old children with appropriate quality assessment in place. However, custom templates may be needed to optimize the results for the subcortical areas. Through visual assessment on a level of individual regions of interest, our semiautomated segmentation protocol is hopefully helpful for investigators working with similar data sets, and for ensuring high quality pediatric neuroimaging data.
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Affiliation(s)
- Elmo P. Pulli
- Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Psychiatry, Turku University Hospital, University of Turku, Turku, Finland
| | - Eero Silver
- Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Psychiatry, Turku University Hospital, University of Turku, Turku, Finland
| | - Venla Kumpulainen
- Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Psychiatry, Turku University Hospital, University of Turku, Turku, Finland
| | - Anni Copeland
- Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Harri Merisaari
- Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Radiology, University of Turku, Turku, Finland
| | - Jani Saunavaara
- Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Riitta Parkkola
- Department of Radiology, University of Turku, Turku, Finland
- Department of Radiology, Turku University Hospital, Turku, Finland
| | - Tuire Lähdesmäki
- Department of Pediatrics and Adolescent Medicine, Turku University Hospital, University of Turku, Turku, Finland
| | - Ekaterina Saukko
- Department of Radiology, Turku University Hospital, Turku, Finland
| | - Saara Nolvi
- Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Turku Institute for Advanced Studies, University of Turku, Turku, Finland
- Department of Psychology, University of Turku, Turku, Finland
| | - Eeva-Leena Kataja
- Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Riikka Korja
- Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Psychology, University of Turku, Turku, Finland
| | - Linnea Karlsson
- Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Psychiatry, Turku University Hospital, University of Turku, Turku, Finland
- Centre for Population Health Research, Turku University Hospital, University of Turku, Turku, Finland
| | - Hasse Karlsson
- Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Psychiatry, Turku University Hospital, University of Turku, Turku, Finland
- Centre for Population Health Research, Turku University Hospital, University of Turku, Turku, Finland
| | - Jetro J. Tuulari
- Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Psychiatry, Turku University Hospital, University of Turku, Turku, Finland
- Turku Collegium for Science, Medicine and Technology, University of Turku, Turku, Finland
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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27
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A Descriptive Review of the Impact of Patient Motion in Early Childhood Resting-State Functional Magnetic Resonance Imaging. Diagnostics (Basel) 2022; 12:diagnostics12051032. [PMID: 35626188 PMCID: PMC9140169 DOI: 10.3390/diagnostics12051032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/08/2022] [Accepted: 04/19/2022] [Indexed: 11/18/2022] Open
Abstract
Resting-state functional magnetic images (rs-fMRIs) can be used to map and delineate the brain activity occurring while the patient is in a task-free state. These resting-state activity networks can be informative when diagnosing various neurodevelopmental diseases, but only if the images are high quality. The quality of an rs-fMRI rapidly degrades when the patient moves during the scan. Herein, we describe how patient motion impacts an rs-fMRI on multiple levels. We begin with how the electromagnetic field and pulses of an MR scanner interact with a patient’s physiology, how movement affects the net signal acquired by the scanner, and how motion can be quantified from rs-fMRI. We then present methods for preventing motion through educational and behavioral interventions appropriate for different age groups, techniques for prospectively monitoring and correcting motion during the acquisition process, and pipelines for mitigating the effects of motion in existing scans.
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28
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Bahrami M, Simpson SL, Burdette JH, Lyday RG, Quandt SA, Chen H, Arcury TA, Laurienti PJ. Altered Default Mode Network Associated with Pesticide Exposure in Latinx Children from Rural Farmworker Families. Neuroimage 2022; 256:119179. [PMID: 35429626 PMCID: PMC9251855 DOI: 10.1016/j.neuroimage.2022.119179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 03/03/2022] [Accepted: 04/03/2022] [Indexed: 01/21/2023] Open
Abstract
Pesticide exposure has been associated with adverse cognitive and neurological effects. However, neuroimaging studies aimed at examining the impacts of pesticide exposure on brain networks underlying abnormal neurodevelopment in children remain limited. It has been demonstrated that pesticide exposure in children is associated with disrupted brain anatomy in regions that make up the default mode network (DMN), a subnetwork engaged across a diverse set of cognitive processes, particularly higher-order cognitive tasks. This study tested the hypothesis that functional brain network connectivity/topology in Latinx children from rural farmworker families (FW children) would differ from urban Latinx children from non-farmworker families (NFW children). We also tested the hypothesis that probable historic childhood exposure to pesticides among FW children would be associated with network connectivity/topology in a manner that parallels differences between FW and NFW children. We used brain networks from functional magnetic resonance imaging (fMRI) data from 78 children and a mixed-effects regression framework to test our hypotheses. We found that network topology was differently associated with the connection probability between FW and NFW children in the DMN. Our results also indicated that, among 48 FW children, historic reports of exposure to pesticides from prenatal to 96 months old were significantly associated with DMN topology, as hypothesized. Although the cause of the differences in brain networks between FW and NFW children cannot be determined using a cross-sectional study design, the observed associations between network connectivity/topology and historic exposure reports in FW children provide compelling evidence for a contribution of pesticide exposure on altering the DMN network organization in this vulnerable population. Although longitudinal follow-up of the children is necessary to further elucidate the cause and reveal the ultimate neurological implications, these findings raise serious concerns about the potential adverse health consequences from developmental neurotoxicity associated with pesticide exposure in this vulnerable population.
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Affiliation(s)
- Mohsen Bahrami
- Laboratory for Complex Brain Networks, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA.
| | - Sean L Simpson
- Laboratory for Complex Brain Networks, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jonathan H Burdette
- Laboratory for Complex Brain Networks, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Robert G Lyday
- Laboratory for Complex Brain Networks, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Sara A Quandt
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Haiying Chen
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Thomas A Arcury
- Department of Family and Community Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Paul J Laurienti
- Laboratory for Complex Brain Networks, Wake Forest School of Medicine, Winston-Salem, NC, USA; Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA
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29
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Bruno JL, Shrestha SB, Reiss AL, Saggar M, Green T. Altered canonical and striatal-frontal resting state functional connectivity in children with pathogenic variants in the Ras/mitogen-activated protein kinase pathway. Mol Psychiatry 2022; 27:1542-1551. [PMID: 35087195 PMCID: PMC9106817 DOI: 10.1038/s41380-021-01422-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 12/02/2021] [Accepted: 12/09/2021] [Indexed: 11/09/2022]
Abstract
Mounting evidence supports the role of the Ras/mitogen-activated protein kinase (Ras/MAPK) pathway in neurodevelopmental disorders. Here, the authors used a genetics-first approach to examine how Ras/MAPK pathogenic variants affect the functional organization of the brain and cognitive phenotypes including weaknesses in attention and inhibition. Functional MRI was used to examine resting state functional connectivity (RSFC) in association with Ras/MAPK pathogenic variants in children with Noonan syndrome (NS). Participants (age 4-12 years) included 39 children with NS (mean age 8.44, SD = 2.20, 25 females) and 49 typically developing (TD) children (mean age 9.02, SD = 9.02, 33 females). Twenty-eight children in the NS group and 46 in the TD group had usable MRI data and were included in final analyses. The results indicated significant hyperconnectivity for the NS group within canonical visual, ventral attention, left frontoparietal and limbic networks (p < 0.05 FWE). Higher connectivity within canonical left frontoparietal and limbic networks positively correlated with cognitive function within the NS but not the TD group. Further, the NS group demonstrated significant group differences in seed-based striatal-frontal connectivity (Z > 2.6, p < 0.05 FWE). Hyperconnectivity within canonical brain networks may represent an intermediary phenotype between Ras/MAPK pathogenic variants and cognitive phenotypes, including weaknesses in attention and inhibition. Altered striatal-frontal connectivity corresponds with smaller striatal volume and altered white matter connectivity previously documented in children with NS. These results may indicate delayed maturation and compensatory mechanisms and they are important for understanding the pathophysiology underlying cognitive phenotypes in NS and in the broader population of children with neurodevelopmental disorders.
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Affiliation(s)
- Jennifer L Bruno
- Division of Interdisciplinary Brain Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
| | - Sharon B Shrestha
- Division of Interdisciplinary Brain Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Allan L Reiss
- Division of Interdisciplinary Brain Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Department of Pediatrics and Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Manish Saggar
- Division of Interdisciplinary Brain Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Tamar Green
- Division of Interdisciplinary Brain Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
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30
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Al-Sarhani H, Gottumukkala RV, Grasparil ADS, Tung EL, Gee MS, Greer MLC. Screening of cancer predisposition syndromes. Pediatr Radiol 2022; 52:401-417. [PMID: 33791839 DOI: 10.1007/s00247-021-05023-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/14/2021] [Accepted: 02/17/2021] [Indexed: 12/19/2022]
Abstract
Pediatric patients with cancer predisposition syndromes are at increased risk of developing malignancies compared with their age-matched peers, necessitating regular surveillance. Screening protocols differ among syndromes and are composed of a number of elements, imaging being one. Surveillance can be initiated in infants, children and adolescents with a tumor known or suspected of being related to a cancer predisposition syndrome or where genetic testing identifies a germline pathogenic gene variant in an asymptomatic child. Pre-symptomatic detection of malignant neoplasms offers potential to improve treatment options and survival outcomes, but the benefits and risks of screening need to be weighed, particularly with variable penetrance in many cancer predisposition syndromes. In this review we discuss the benefits and risks of surveillance imaging and the importance of integrating imaging and non-imaging screening elements. We explore the principles of surveillance imaging with particular reference to whole-body MRI, considering the strategies to minimize false-negative and manage false-positive whole-body MRI results, the value of standardized nomenclature when reporting risk stratification to better guide patient management, and the need for timely communication of results to allay anxiety. Cancer predisposition syndrome screening is a multimodality, multidisciplinary and longitudinal process, so developing formalized frameworks for surveillance imaging programs should enhance diagnostic performance while improving the patient experience.
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Affiliation(s)
- Haifa Al-Sarhani
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Ravi V Gottumukkala
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Angelo Don S Grasparil
- Department of Radiological Sciences, Cardinal Santos Medical Center, San Juan City, Philippines
| | - Eric L Tung
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Mary-Louise C Greer
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada. .,Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
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31
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Goetstouwers S, Kempink D, The B, Eygendaal D, van Oirschot B, van Bergen CJA. Three-dimensional printing in paediatric orthopaedic surgery. World J Orthop 2022; 13:1-10. [PMID: 35096533 PMCID: PMC8771415 DOI: 10.5312/wjo.v13.i1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 07/29/2021] [Accepted: 12/21/2021] [Indexed: 02/06/2023] Open
Abstract
Three-dimensional (3D) printing is a rapidly evolving and promising field to improve outcomes of orthopaedic surgery. The use of patient-specific 3D-printed models is specifically interesting in paediatric orthopaedic surgery, as limb deformity corrections often require an individual 3D treatment. In this editorial, various operative applications of 3D printing in paediatric orthopaedic surgery are discussed. The technical aspects and the imaging acquisition with computed tomography and magnetic resonance imaging are outlined. Next, there is a focus on the intraoperative applications of 3D printing during paediatric orthopaedic surgical procedures. An overview of various upper and lower limb deformities in paediatrics is given, in which 3D printing is already implemented, including post-traumatic forearm corrections and proximal femoral osteotomies. The use of patient-specific instrumentation (PSI) or guiding templates during the surgical procedure shows to be promising in reducing operation time, intraoperative haemorrhage and radiation exposure. Moreover, 3D-printed models for the use of PSI or patient-specific navigation templates are promising in improving the accuracy of complex limb deformity surgery in children. Lastly, the future of 3D printing in paediatric orthopaedics extends beyond the intraoperative applications; various other medical applications include 3D casting and prosthetic limb replacement. In conclusion, 3D printing opportunities are numerous, and the fast developments are exciting, but more evidence is required to prove its superiority over conventional paediatric orthopaedic surgery.
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Affiliation(s)
- Sven Goetstouwers
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus Medical Centre/Sophia Children's Hospital, Rotterdam 3015GD, South-Holland, Netherlands
| | - Dagmar Kempink
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus Medical Centre/Sophia Children's Hospital, Rotterdam 3015GD, South-Holland, Netherlands
| | - Bertram The
- Department of Orthopaedic Surgery, Amphia Hospital, Breda 4818CK, North-Brabant, Netherlands
| | - Denise Eygendaal
- Department of Orthopaedic Surgery and Sports Medicine, Erasmus Medical Centre/Sophia Children's Hospital, Rotterdam 3015GD, South-Holland, Netherlands
- Department of Orthopaedic Surgery, Amphia Hospital, Breda 4818CK, North-Brabant, Netherlands
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Johnson CA, Garnett EO, Chow HM, Spray GJ, Zhu DC, Chang SE. Developmental Factors That Predict Head Movement During Resting-State Functional Magnetic Resonance Imaging in 3-7-Year-Old Stuttering and Non-stuttering Children. Front Neurosci 2021; 15:753010. [PMID: 34803590 PMCID: PMC8595248 DOI: 10.3389/fnins.2021.753010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/14/2021] [Indexed: 11/30/2022] Open
Abstract
Early childhood marks a period of dynamic neurocognitive development. Preschool-age coincides with the onset of many childhood disorders and is a developmental period that is frequently studied to determine markers of neurodevelopmental disorders. Magnetic resonance imaging (MRI) is often used to explore typical brain development and the neural bases of neurodevelopmental disorders. However, acquiring high-quality MRI data in young children is challenging. The enclosed space and loud sounds can trigger unease and cause excessive head movement. A better understanding of potential factors that predict successful MRI acquisition would increase chances of collecting useable data in children with and without neurodevelopmental disorders. We investigated whether age, sex, stuttering status, and childhood temperament as measured using the Child Behavioral Questionnaire, could predict movement extent during resting-state functional MRI (rs-fMRI) in 76 children aged 3–7 years, including 42 children who stutter (CWS). We found that age, sex, and temperament factors could predict motion during rs-fMRI scans. The CWS were not found to differ significantly from controls in temperament or head movement during scanning. Sex and age were significant predictors of movement. However, age was no longer a significant predictor when temperament, specifically effortful control, was considered. Controlling for age, boys with higher effortful control scores moved less during rs-fMRI procedures. Additionally, boys who showed higher negative affectivity showed a trend for greater movement. Considering temperament factors in addition to age and sex may help predict the success of acquiring useable rs-fMRI (and likely general brain MRI) data in young children in MR neuroimaging.
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Affiliation(s)
- Chelsea A Johnson
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI, United States
| | - Emily O Garnett
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Ho Ming Chow
- Department of Communication Sciences and Disorders, University of Delaware, Newark, DE, United States
| | - Gregory J Spray
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI, United States
| | - David C Zhu
- Department of Radiology and Cognitive Imaging Research Center, Michigan State University, East Lansing, MI, United States
| | - Soo-Eun Chang
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI, United States.,Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
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Stunden C, Stratton K, Zakani S, Jacob J. 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. J Med Internet Res 2021; 23:e22942. [PMID: 34550072 PMCID: PMC8495586 DOI: 10.2196/22942] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/23/2020] [Accepted: 07/19/2021] [Indexed: 01/16/2023] Open
Abstract
Background The 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. Objective This 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. Methods This 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). Results A 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). Conclusions Digital 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 Registration Clinicaltrials.gov NCT03931382; https://clinicaltrials.gov/ct2/show/NCT03931382
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Affiliation(s)
- Chelsea Stunden
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Digital Lab at BC Children's Hospital, Vancouver, BC, Canada
| | - Kirsten Stratton
- Department of Child Life, BC Children's Hospital, Vancouver, BC, Canada
| | - Sima Zakani
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Digital Lab at BC Children's Hospital, Vancouver, BC, Canada
| | - John Jacob
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.,Digital Lab at BC Children's Hospital, Vancouver, BC, Canada.,City University of London, London, United Kingdom
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34
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Lee CH, Bartholomay KL, Marzelli MJ, Miller JG, Bruno JL, Lightbody AA, Reiss AL. Neuroanatomical Profile of Young Females with Fragile X Syndrome: A Voxel-Based Morphometry Analysis. Cereb Cortex 2021; 32:2310-2320. [PMID: 34546362 DOI: 10.1093/cercor/bhab319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 11/12/2022] Open
Abstract
Fragile X syndrome is a genetic condition associated with alterations in brain and subsequent cognitive development. However, due to a milder phenotype relative to males, females with fragile X syndrome are underrepresented in research studies. In the current study, we investigate neuroanatomical differences in young females (age range: 6.03-16.32 years) with fragile X syndrome (N = 46) as compared to age-, sex-, and verbal abilities-matched participants (comparison group; N = 35). Between-group analyses of whole-brain and regional brain volumes were assessed using voxel-based morphometry. Results demonstrate significantly larger total gray and white matter volumes in girls with fragile X syndrome compared to a matched comparison group (Ps < 0.001). In addition, the fragile X group showed significantly larger gray matter volume in a bilateral parieto-occipital cluster and a right parieto-occipital cluster (Ps < 0.001). Conversely, the fragile X group showed significantly smaller gray matter volume in the bilateral gyrus rectus (P < 0.03). Associations between these regional brain volumes and key socio-emotional variables provide insight into gene-brain-behavior relationships underlying the fragile X syndrome phenotype in females. These findings represent the first characterization of a neuroanatomical phenotype in a large sample of girls with fragile X syndrome and expand our knowledge about potential neurodevelopmental mechanisms underlying cognitive-behavioral outcomes in this condition.
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Affiliation(s)
- Cindy H Lee
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
| | - Kristi L Bartholomay
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
| | - Matthew J Marzelli
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
| | - Jonas G Miller
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
| | - Jennifer L Bruno
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
| | - Amy A Lightbody
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
| | - Allan L Reiss
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, CA 94305, USA.,Department of Radiology, Stanford University, Stanford, CA 94305, USA.,Department of Pediatrics, Stanford University, Palo Alto, CA 94304, USA
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35
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Simhal AK, Filho JOA, Segura P, Cloud J, Petkova E, Gallagher R, Castellanos FX, Colcombe S, Milham MP, Di Martino A. Predicting multiscan MRI outcomes in children with neurodevelopmental conditions following MRI simulator training. Dev Cogn Neurosci 2021; 52:101009. [PMID: 34649041 PMCID: PMC8517836 DOI: 10.1016/j.dcn.2021.101009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 08/16/2021] [Accepted: 08/25/2021] [Indexed: 11/20/2022] Open
Abstract
Pediatric brain imaging holds significant promise for understanding neurodevelopment. However, the requirement to remain still inside a noisy, enclosed scanner remains a challenge. Verbal or visual descriptions of the process, and/or practice in MRI simulators are the norm in preparing children. Yet, the factors predictive of successfully obtaining neuroimaging data remain unclear. We examined data from 250 children (6–12 years, 197 males) with autism and/or attention-deficit/hyperactivity disorder. Children completed systematic MRI simulator training aimed to habituate to the scanner environment and minimize head motion. An MRI session comprised multiple structural, resting-state, task and diffusion scans. Of the 201 children passing simulator training and attempting scanning, nearly all (94%) successfully completed the first structural scan in the sequence, and 88% also completed the following functional scan. The number of successful scans decreased as the sequence progressed. Multivariate analyses revealed that age was the strongest predictor of successful scans in the session, with younger children having lower success rates. After age, sensorimotor atypicalities contributed most to prediction. Results provide insights on factors to consider in designing pediatric brain imaging protocols.
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Affiliation(s)
| | | | | | - Jessica Cloud
- Center for Biomedical Imaging and Neuromodulation, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Eva Petkova
- Department of Population Health, Hassenfeld Children's Hospital at NYU Langone Health, New York, NY, USA; Department of Child and Adolescent Psychiatry, Hassenfeld Children's Hospital at NYU Langone Health, New York, NY, USA
| | - Richard Gallagher
- Department of Child and Adolescent Psychiatry, Hassenfeld Children's Hospital at NYU Langone Health, New York, NY, USA
| | - F Xavier Castellanos
- Department of Child and Adolescent Psychiatry, Hassenfeld Children's Hospital at NYU Langone Health, New York, NY, USA; Center for Biomedical Imaging and Neuromodulation, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Stan Colcombe
- Center for Biomedical Imaging and Neuromodulation, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Michael P Milham
- Center for Biomedical Imaging and Neuromodulation, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA; Center for the Developing Brain, Child Mind Institute, New York, NY, USA
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Copeland A, Silver E, Korja R, Lehtola SJ, Merisaari H, Saukko E, Sinisalo S, Saunavaara J, Lähdesmäki T, Parkkola R, Nolvi S, Karlsson L, Karlsson H, Tuulari JJ. Infant and Child MRI: A Review of Scanning Procedures. Front Neurosci 2021; 15:666020. [PMID: 34321992 PMCID: PMC8311184 DOI: 10.3389/fnins.2021.666020] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/04/2021] [Indexed: 12/13/2022] Open
Abstract
Magnetic resonance imaging (MRI) is a safe method to examine human brain. However, a typical MR scan is very sensitive to motion, and it requires the subject to lie still during the acquisition, which is a major challenge for pediatric scans. Consequently, in a clinical setting, sedation or general anesthesia is often used. In the research setting including healthy subjects anesthetics are not recommended for ethical reasons and potential longer-term harm. Here we review the methods used to prepare a child for an MRI scan, but also on the techniques and tools used during the scanning to enable a successful scan. Additionally, we critically evaluate how studies have reported the scanning procedure and success of scanning. We searched articles based on special subject headings from PubMed and identified 86 studies using brain MRI in healthy subjects between 0 and 6 years of age. Scan preparations expectedly depended on subject's age; infants and young children were scanned asleep after feeding and swaddling and older children were scanned awake. Comparing the efficiency of different procedures was difficult because of the heterogeneous reporting of the used methods and the success rates. Based on this review, we recommend more detailed reporting of scanning procedure to help find out which are the factors affecting the success of scanning. In the long term, this could help the research field to get high quality data, but also the clinical field to reduce the use of anesthetics. Finally, we introduce the protocol used in scanning 2 to 5-week-old infants in the FinnBrain Birth Cohort Study, and tips for calming neonates during the scans.
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Affiliation(s)
- Anni Copeland
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Psychiatry, Turku University Hospital, University of Turku, Turku, Finland
| | - Eero Silver
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Psychiatry, Turku University Hospital, University of Turku, Turku, Finland
| | - Riikka Korja
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Psychology, University of Turku, Turku, Finland
| | - Satu J. Lehtola
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Harri Merisaari
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Radiology, Turku University Hospital, University of Turku, Turku, Finland
| | - Ekaterina Saukko
- Department of Radiology, Turku University Hospital, University of Turku, Turku, Finland
| | - Susanne Sinisalo
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Jani Saunavaara
- Department of Medical Physics, Turku University Hospital, Turku, Finland
| | - Tuire Lähdesmäki
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Pediatric Neurology, Turku University Hospital, University of Turku, Turku, Finland
| | - Riitta Parkkola
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Radiology, Turku University Hospital, University of Turku, Turku, Finland
| | - Saara Nolvi
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Psychology and Speech-Language Pathology, Turku Institute for Advanced Studies, University of Turku, Turku, Finland
| | - Linnea Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Psychiatry, Turku University Hospital, University of Turku, Turku, Finland
- Centre for Population Health Research, Turku University Hospital, University of Turku, Turku, Finland
| | - Hasse Karlsson
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Psychiatry, Turku University Hospital, University of Turku, Turku, Finland
| | - Jetro J. Tuulari
- FinnBrain Birth Cohort Study, Turku Brain and Mind Center, Department of Clinical Medicine, University of Turku, Turku, Finland
- Department of Psychiatry, Turku University Hospital, University of Turku, Turku, Finland
- Turku Collegium for Science, Medicine and Technology, University of Turku, Turku, Finland
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Dillman JR, Gee MS, Ward CG, Drum ET, States LJ. Imaging sedation and anesthesia practice patterns in pediatric radiology departments - a survey of the Society of Chiefs of Radiology at Children's Hospitals (SCORCH). Pediatr Radiol 2021; 51:1497-1502. [PMID: 33606058 DOI: 10.1007/s00247-021-04996-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 01/04/2021] [Accepted: 01/31/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are few data describing practice patterns related to the use of sedation/anesthesia for diagnostic imaging in pediatric radiology departments. OBJECTIVE To understand current practice patterns related to imaging with sedation/anesthesia in pediatric radiology departments based on a survey of the Society of Chiefs of Radiology at Children's Hospitals (SCORCH) in conjunction with the American College of Radiology's Pediatric Imaging Sedation and Anesthesia Committee. MATERIALS AND METHODS A multi-question survey related to imaging with sedation/anesthesia in pediatric radiology departments was distributed to SCORCH member institutions in January 2019. A single reminder email was sent. Descriptive statistical analyses were performed. RESULTS Of the 84 pediatric radiology departments, 23 (27%) completed the survey. Fifty-seven percent of the respondents self-identified as academic/university-affiliated and 13% as a division/section in an adult radiology department. Imaging sedation (excluding general anesthesia) is commonly performed by pediatric anesthesiologists (76%) and intensive care unit physicians (intensivists, 48%); only 14% of departments expect their pediatric radiologists to supervise imaging sedation. Ninety-six percent of departments use child life specialists for patient preparation. Seventy percent of departments have preparatory resources available on a website, including simulation videos (26%) and audio clips (17%). Nearly half (48%) of the departments have a mock scanner to aid in patient preparation. Imaging sedation/anesthesia is most often scheduled at the request of ordering clinicians (65%), while 57% of departments allow schedulers to place patients into imaging sedation/anesthesia slots based on specified criteria. CONCLUSION Imaging sedation/anesthesia practice patterns vary among pediatric radiology departments, and understanding current approaches can help with standardization and practice improvement.
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Affiliation(s)
- Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave., Cincinnati, OH, 45229-3039, USA.
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher G Ward
- Department of Anesthesiology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth T Drum
- Department of Anesthesiology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa J States
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Mauras N, Buckingham B, White NH, Tsalikian E, Weinzimer SA, Jo B, Cato A, Fox LA, Aye T, Arbelaez AM, Hershey T, Tansey M, Tamborlane W, Foland-Ross LC, Shen H, Englert K, Mazaika P, Marzelli M, Reiss AL. Impact of Type 1 Diabetes in the Developing Brain in Children: A Longitudinal Study. Diabetes Care 2021; 44:983-992. [PMID: 33568403 PMCID: PMC7985430 DOI: 10.2337/dc20-2125] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 01/05/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess whether previously observed brain and cognitive differences between children with type 1 diabetes and control subjects without diabetes persist, worsen, or improve as children grow into puberty and whether differences are associated with hyperglycemia. RESEARCH DESIGN AND METHODS One hundred forty-four children with type 1 diabetes and 72 age-matched control subjects without diabetes (mean ± SD age at baseline 7.0 ± 1.7 years, 46% female) had unsedated MRI and cognitive testing up to four times over 6.4 ± 0.4 (range 5.3-7.8) years; HbA1c and continuous glucose monitoring were done quarterly. FreeSurfer-derived brain volumes and cognitive metrics assessed longitudinally were compared between groups using mixed-effects models at 6, 8, 10, and 12 years. Correlations with glycemia were performed. RESULTS Total brain, gray, and white matter volumes and full-scale and verbal intelligence quotients (IQs) were lower in the diabetes group at 6, 8, 10, and 12 years, with estimated group differences in full-scale IQ of -4.15, -3.81, -3.46, and -3.11, respectively (P < 0.05), and total brain volume differences of -15,410, -21,159, -25,548, and -28,577 mm3 at 6, 8, 10, and 12 years, respectively (P < 0.05). Differences at baseline persisted or increased over time, and brain volumes and cognitive scores negatively correlated with a life-long HbA1c index and higher sensor glucose in diabetes. CONCLUSIONS Detectable changes in brain volumes and cognitive scores persist over time in children with early-onset type 1 diabetes followed longitudinally; these differences are associated with metrics of hyperglycemia. Whether these changes can be reversed with scrupulous diabetes control requires further study. These longitudinal data support the hypothesis that the brain is a target of diabetes complications in young children.
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Affiliation(s)
- Nelly Mauras
- Division of Endocrinology, Diabetes & Metabolism, Department of Pediatrics, Nemours Children's Health System, Jacksonville, FL
| | - Bruce Buckingham
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University, Stanford, CA
| | - Neil H White
- Division of Endocrinology and Diabetes, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| | - Eva Tsalikian
- Division of Endocrinology and Diabetes, Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA
| | | | - Booil Jo
- Center for Interdisciplinary Brain Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Allison Cato
- Division of Neurology, Nemours Children's Health System, Jacksonville, FL
| | - Larry A Fox
- Division of Endocrinology, Diabetes & Metabolism, Department of Pediatrics, Nemours Children's Health System, Jacksonville, FL
| | - Tandy Aye
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University, Stanford, CA
| | - Ana Maria Arbelaez
- Division of Endocrinology and Diabetes, Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| | - Tamara Hershey
- Departments of Radiology and Psychiatry, Washington University in St. Louis, St. Louis, MO
| | - Michael Tansey
- Division of Endocrinology and Diabetes, Stead Family Department of Pediatrics, University of Iowa, Iowa City, IA
| | | | - Lara C Foland-Ross
- Center for Interdisciplinary Brain Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Hanyang Shen
- Center for Interdisciplinary Brain Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Kimberly Englert
- Division of Endocrinology, Diabetes & Metabolism, Department of Pediatrics, Nemours Children's Health System, Jacksonville, FL
| | - Paul Mazaika
- Center for Interdisciplinary Brain Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Matthew Marzelli
- Center for Interdisciplinary Brain Sciences, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
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Bruno JL, Hong DS, Lightbody AA, Hosseini SMH, Hallmayer J, Reiss AL. Glucocorticoid regulation and neuroanatomy in fragile x syndrome. J Psychiatr Res 2021; 134:81-88. [PMID: 33373777 PMCID: PMC8577316 DOI: 10.1016/j.jpsychires.2020.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 10/18/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
Fragile X syndrome (FXS) is the leading known inherited cause for intellectual disability. Due to mutations in the FMR1 gene, affected individuals are at risk for serious cognitive and behavioral symptoms and developmental disability. Clinical presentation varies considerably, and investigation of genetic factors not directly related to FMR1 may help better understand variability. The present study examined the BclI polymorphism of the glucocorticoid receptor gene NR3C1 in 43 individuals with FXS (28 females, age 16 to 25). Females with FXS who presented with one or more G alleles demonstrated attenuated symptoms of anxiety/depression (p = 0.038) and externalizing behaviors (p = 0.042) relative to individuals with the C/C allele. In the combined sample (males and females) structural neuroimaging data differentiated individuals with a G allele from those with the C/C genotype (p < 0.001). Key components of anxiety/fear neurocircuitry (amygdala, insula) contributed more (relative to other regions) to the model differentiating groups. These results indicate that GR polymorphisms are associated with an altered pattern of behavioral and brain development in FXS. This information is important for understanding and treating mood disorders and altered brain development among individuals with FXS. With further research, these findings could be informative for understanding anxiety and mood disorders more broadly.
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Affiliation(s)
- Jennifer L Bruno
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94304, USA.
| | - David S Hong
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94304, USA
| | - Amy A Lightbody
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94304, USA
| | - S M Hadi Hosseini
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94304, USA
| | - Joachim Hallmayer
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94304, USA
| | - Allan L Reiss
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, 94304, USA; Department of Radiology, Stanford University, Stanford, CA, 94304, USA; Department of Pediatrics, Stanford University, Stanford, CA, 94304, USA.
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40
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Gentle Touch: Noninvasive Approaches to Improve Patient Comfort and Cooperation for Pediatric Imaging. Top Magn Reson Imaging 2021; 29:187-195. [PMID: 32541256 DOI: 10.1097/rmr.0000000000000245] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Pediatric imaging presents unique challenges related to patient anxiety, cooperation, and safety. Techniques to reduce anxiety and patient motion in adults must often be augmented in pediatrics, because it is always mentioned in the field of pediatrics, children are not miniature adults. This article will review methods that can be considered to improve patient experience and cooperation in imaging studies. Such techniques can range from modifications to the scanner suite, different ways of preparing and interacting with children, collaborating with parents for improved patient care, and technical advances such as accelerated acquisition and motion correction to reduce artifact. Special considerations for specific populations including transgender patients, neonates, and pregnant women undergoing fetal imaging will be described. The unique risks of sedation in children will also be briefly reviewed.
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41
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Tziraki M, Garg S, Harrison E, Wright NB, Hawkes R, Akhtar K, Green J, Stivaros S. A Neuroimaging Preparation Protocol Tailored for Autism. Autism Res 2020; 14:65-74. [PMID: 33150732 DOI: 10.1002/aur.2427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 11/09/2022]
Abstract
This paper describes the key basic elements required for a successful multi-parametric MRI data acquisition in awake children with autism. The procedure was designed by taking into account methodological challenges arising from the acquisition of Resting State fMRI (RS fMRI) data, and factors such as cost, time, and staff availability. The ultimate aim was to prepare an imaging preparation protocol with high transferability to the whole autism spectrum, adaptable for use in a multi-site research with multiple time points. As part of a randomized pharmaco-intervention study, 31 children aged 4-10 years with Neurofibromatosis 1 and autism underwent MR imaging at baseline and end of intervention. The protocol consisted of tailored habituation instructions including gradual exposure to scanner noise, a social stories booklet, positive incentive strategies, and Play Therapy support. Success rate for initial acquisition was 71% for GABA+ MR spectroscopy at either location, 87% for perfusion, and 67% for diffusion assessment, and 71% for RS fMRI. Qualitative data indicated that 84% parents found the habituation protocol helpful. LAY SUMMARY: Here we describe a protocol for brain Magnetic Resonance Imaging (MRI) tailored for children with ASD to help reduce stress and avoid sedation during scanning. This procedure can make advanced medical imaging more accessible and promote a better MRI experience for families of children with ASD.
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Affiliation(s)
- Maria Tziraki
- Psychology Department, CITY College, International Faculty of the University of Sheffield, Thessaloniki, Greece
| | - Shruti Garg
- Division of Neuroscience & Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Emma Harrison
- NIHR Clinical Research Facility, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Neville B Wright
- Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Rob Hawkes
- Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Kapasi Akhtar
- Division of Neuroscience & Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Jonathan Green
- Division of Neuroscience & Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Stavros Stivaros
- Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,Division of Informatics, Imaging and Data Sciences, School of Health Sciences, University of Manchester & Academic Unit of Paediatric Radiology, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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42
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Participant-driven Simulation Protocol With a Mock Scanner for Pediatric Magnetic Resonance Neuroimaging Preparation Without Sedation. Clin Simul Nurs 2020. [DOI: 10.1016/j.ecns.2020.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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43
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Howlett M, Chorney J. The MRI Self-Efficacy Scale for Children: Development and Preliminary Psychometrics. J Pediatr Psychol 2020; 45:736-748. [PMID: 32632443 DOI: 10.1093/jpepsy/jsaa045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 05/11/2020] [Accepted: 05/19/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Magnetic resonance imaging (MRI) is a common procedure that can be distressing for children. Although not yet studied in the context of pediatric medical procedures, self-efficacy may be a good predictor of procedural stress and a clinically feasible target for behavioral intervention. The objectives of this study were to develop the MRI Self-Efficacy Scale for Children (MRI-SEC) and assess the preliminary psychometric properties. METHODS Development of the MRI-SEC was informed by literature searches and feedback from healthcare providers. Twenty child-parent dyads naïve to MRI and 10 child-parent dyads with MRI experience completed the MRI-SEC to assess the comprehensibility and ease of use, and to inform item and scale refinement. The final version includes four practice items and 12 items directly assessing MRI self-efficacy. To evaluate the psychometric properties, 127 children (ages 6-12) and parents naïve to MRI completed the MRI-SEC, and a series of measures to assess construct validity. To evaluate test-retest reliability 27 children completed the MRI-SEC a second time. RESULTS The MRI-SEC demonstrated acceptable internal consistency, test-retest reliability, and convergent validity. CONCLUSION Development of the MRI-SEC provides an opportunity to better understand the role of self-efficacy as a predictor of procedural stress and cooperation with MRI, informing reliable prediction of children who may benefit from additional support for MRI and the development of tailored behavioral interventions.
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Affiliation(s)
- Melissa Howlett
- Department of Psychology & Neuroscience, Dalhousie University.,Centre for Pediatric Pain Research, IWK Health Centre
| | - Jill Chorney
- Department of Psychology & Neuroscience, Dalhousie University.,Centre for Pediatric Pain Research, IWK Health Centre.,Department of Psychiatry, Dalhousie University
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44
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Foland-Ross LC, Tong G, Mauras N, Cato A, Aye T, Tansey M, White NH, Weinzimer SA, Englert K, Shen H, Mazaika PK, Reiss AL. Brain Function Differences in Children With Type 1 Diabetes: A Functional MRI Study of Working Memory. Diabetes 2020; 69:1770-1778. [PMID: 32471809 PMCID: PMC7372069 DOI: 10.2337/db20-0123] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 05/21/2020] [Indexed: 12/12/2022]
Abstract
Glucose is a primary fuel source to the brain, yet the influence of dysglycemia on neurodevelopment in children with type 1 diabetes remains unclear. We examined brain activation using functional MRI in 80 children with type 1 diabetes (mean ± SD age 11.5 ± 1.8 years; 46% female) and 47 children without diabetes (control group) (age 11.8 ± 1.5 years; 51% female) as they performed a visuospatial working memory (N-back) task. Results indicated that in both groups, activation scaled positively with increasing working memory load across many areas, including the frontoparietal cortex, caudate, and cerebellum. Between groups, children with diabetes exhibited reduced performance on the N-back task relative to children in the control group, as well as greater modulation of activation (i.e., showed greater increase in activation with higher working memory load). Post hoc analyses indicated that greater modulation was associated in the diabetes group with better working memory function and with an earlier age of diagnosis. These findings suggest that increased modulation may occur as a compensatory mechanism, helping in part to preserve working memory ability, and further, that children with an earlier onset require additional compensation. Future studies that test whether these patterns change as a function of improved glycemic control are warranted.
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Affiliation(s)
- Lara C Foland-Ross
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Gabby Tong
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Nelly Mauras
- Division of Endocrinology, Diabetes and Metabolism, Nemours Children's Health System, Jacksonville, FL
| | - Allison Cato
- Division of Neurology, Nemours Children's Health System, Jacksonville, FL
| | - Tandy Aye
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Michael Tansey
- Department of Pediatrics, The University of Iowa, Iowa City, IA
| | - Neil H White
- Department of Pediatrics, Washington University in St. Louis and the St. Louis Children's Hospital, St. Louis, MO
| | | | - Kimberly Englert
- Division of Endocrinology, Diabetes and Metabolism, Nemours Children's Health System, Jacksonville, FL
| | - Hanyang Shen
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
| | - Paul K Mazaika
- Center for Interdisciplinary Brain Sciences Research, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA
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45
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Schabdach JM, Ceschin R, Lee VK, Schmithorst V, Panigrahy A. A Series Registration Framework to Recover Resting-State Functional Magnetic Resonance Data Degraded By Motion. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE PROCEEDINGS. AMIA JOINT SUMMITS ON TRANSLATIONAL SCIENCE 2020; 2020:569-578. [PMID: 32477679 PMCID: PMC7233096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Data retention is a significant problem in the medical imaging domain. For example, resting-state functional magnetic resonance images (rs-fMRIs) are invaluable for studying neurodevelopment but are highly susceptible to corruption due to patient motion. The effects of patient motion can be reduced through post-acquisition techniques such as volume registration. Traditional volume registration minimizes the global differences between all volumes in the rs-fMRI sequence and a designated reference volume. We suggest using the spatiotemporal relationships between subsequent image volumes to inform the registration: they are used initialize each volume registration to reduce local differences between volumes while minimizing global differences. We apply both the traditional and novel registration methods to a set of healthy human neonatal rs-fMRIs with significant motion artifacts (N=17). Both methods impacted the mean and standard deviation of the image sequences' correlation ratio matrices similarly; however, the novel framework was more effective in meeting gold standard motion thresholds.
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Affiliation(s)
- Jenna M Schabdach
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rafael Ceschin
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Pediatric Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Vince K Lee
- Department of Pediatric Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Vincent Schmithorst
- Department of Pediatric Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ashok Panigrahy
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania
- Department of Pediatric Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
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46
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Meissner TW, Walbrin J, Nordt M, Koldewyn K, Weigelt S. Head motion during fMRI tasks is reduced in children and adults if participants take breaks. Dev Cogn Neurosci 2020; 44:100803. [PMID: 32716852 PMCID: PMC7284013 DOI: 10.1016/j.dcn.2020.100803] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 04/20/2020] [Accepted: 05/27/2020] [Indexed: 12/30/2022] Open
Abstract
In children, fMRI data acquisition split into multiple sessions reduces head motion. In adults, fMRI data acquisition split by inside-scanner breaks reduces head motion. In both children and adults, motion increases over the duration of a study. In both children and adults, motion increases over the duration of a run. Head motion remains a challenging confound in functional magnetic resonance imaging (fMRI) studies of both children and adults. Most pediatric neuroimaging labs have developed experience-based, child-friendly standards concerning e.g. the maximum length of a session or the time between mock scanner training and actual scanning. However, it is unclear which factors of child-friendly neuroimaging approaches are effective in reducing head motion. Here, we investigate three main factors including (i) time lag of mock scanner training to the actual scan, (ii) prior scan time, and (iii) task engagement in a dataset of 77 children (aged 6–13) and 64 adults (aged 18–35) using a multilevel modeling approach. In children, distributing fMRI data acquisition across multiple same-day sessions reduces head motion. In adults, motion is reduced after inside-scanner breaks. Despite these positive effects of splitting up data acquisition, motion increases over the course of a study as well as over the course of a run in both children and adults. Our results suggest that splitting up fMRI data acquisition is an effective tool to reduce head motion in general. At the same time, different ways of splitting up data acquisition benefit children and adults.
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Affiliation(s)
- Tobias W Meissner
- TU Dortmund University, Faculty of Rehabilitation Sciences, Department of Vision, Visual Impairments & Blindness, Emil-Figge-Str. 50, 44227, Dortmund, Germany; Ruhr University Bochum, Faculty of Psychology, Universitätsstr. 150, 44801, Bochum, Germany.
| | - Jon Walbrin
- Bangor University, School of Psychology, Developmental Social Vision Lab, Penrallt Road, Bangor, LL57 2AS, Wales, United Kingdom; University of Coimbra, Faculty of Psychology and Education Sciences, Proaction Lab, Rua Colégio Novo, 3000-115, Coimbra, Portugal.
| | - Marisa Nordt
- Ruhr University Bochum, Faculty of Psychology, Universitätsstr. 150, 44801, Bochum, Germany; Stanford University, Psychology Department, 450 Serra Mall, Stanford, CA, 94305, USA.
| | - Kami Koldewyn
- Bangor University, School of Psychology, Developmental Social Vision Lab, Penrallt Road, Bangor, LL57 2AS, Wales, United Kingdom.
| | - Sarah Weigelt
- TU Dortmund University, Faculty of Rehabilitation Sciences, Department of Vision, Visual Impairments & Blindness, Emil-Figge-Str. 50, 44227, Dortmund, Germany.
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47
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Black KJ, Kim S, Schlaggar BL, Greene DJ. The New Tics study: A Novel Approach to Pathophysiology and Cause of Tic Disorders. JOURNAL OF PSYCHIATRY AND BRAIN SCIENCE 2020; 5:e200012. [PMID: 32587895 PMCID: PMC7316401 DOI: 10.20900/jpbs.20200012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We report on the ongoing project "The New Tics Study: A Novel Approach to Pathophysiology and Cause of Tic Disorders," describing the work completed to date, ongoing studies and long-term goals. The overall goals of this research are to study the pathophysiology of Provisional Tic Disorder, and to study tic remission (or improvement) in a prospective fashion. Preliminary data collection for the project began almost 10 years ago. The current study is nearing completion of its third year, and has already reported several novel and important results. First, surprisingly, at least 90% of children who had experienced tics for only a mean of 3 months still had tics at the 12-month anniversary of their first tic, though in some cases tics were seen only with remote video observation of the child sitting alone. Thus almost all of them now had a DSM-5 diagnosis of Tourette's Disorder or Persistent (Chronic) Tic Disorder. Baseline clinical features that predicted 12-month outcome included tic severity, subsyndromal autism spectrum symptoms, an anxiety disorder, and a history of 3 or more phonic tics. Second, we found that poorer tic suppression ability when immediately rewarded for suppression predicted greater tic severity at follow-up. Third, striatal volumes did not predict outcome as hypothesized, but a larger hippocampus at baseline predicted worse severity at follow-up. Enrollment and data collection continue, including functional connectivity MRI (fcMRI) imaging, and additional analyses are planned once the full sample is enrolled.
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Affiliation(s)
- Kevin J. Black
- Departments of Psychiatry, Neurology, Radiology and Neuroscience, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Soyoung Kim
- Departments of Psychiatry and Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Bradley L. Schlaggar
- Kennedy Krieger Institute, Baltimore, MD 21205; and Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Deanna J. Greene
- Departments of Psychiatry and Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
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One-Minute Ultrafast Brain MRI With Full Basic Sequences: Can It Be a Promising Way Forward for Pediatric Neuroimaging? AJR Am J Roentgenol 2020; 215:198-205. [PMID: 32255685 DOI: 10.2214/ajr.19.22378] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE. The long scan time of brain MRI is a major drawback that limits its clinical use for evaluating pediatric patients who are inherently prone to motion and frequently require sedatives. This study investigated the clinical feasibility of a 1-minute ultrafast brain MRI protocol in pediatric patients by assessing its image quality in comparison with that of routine brain MRI. MATERIALS AND METHODS. Twenty-three patients were enrolled who underwent 1-minute ultrafast MRI and routine brain MRI protocols including five essential sequences (T1-weighted imaging, T2-weighted imaging, DWI, FLAIR, and T2*-weighted imaging). Total scan time for the same image contrast levels was 1 minute 11 seconds for ultrafast MRI versus 9 minutes 51 seconds for routine brain MRI. Two readers independently reviewed all images from the two MRI protocols and graded the image quality on a 4-point Likert scale. The Wilcoxon signed rank test was used to compare the readers' ratings; interobserver agreement between the readers was also assessed. RESULTS. Although the mean scores of overall image quality and anatomic delineation in ultrafast brain MR images were significantly lower than those in routine brain MR images, ultrafast brain MRI showed sufficient overall image quality and anatomic delineation with more than 2 points on the 4-point scale. CONCLUSION. The 1-minute ultrafast brain MRI protocol showed at least sufficient image quality compared with routine brain MRI. Therefore, 1-minute ultrafast brain MRI can be a viable first-line neuroimaging study for pediatric patients because of its shorter scan time, absence of radiation hazard, and reduced sedation requirements.
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49
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Rudder BS, Easley SJ, Robinson AL, Noel-MacDonnell JR, Nielsen DB. Effects of an MRI Try Without program on patient access. Pediatr Radiol 2019; 49:1712-1717. [PMID: 31392365 DOI: 10.1007/s00247-019-04487-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/09/2019] [Accepted: 07/29/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Pediatric patients are often sedated for magnetic resonance imaging (MRI) scans to ensure images are of diagnostic quality. However, access time for MRIs requiring sedation is often long due to high patient volumes and limited sedation resources. OBJECTIVE This study examined the effectiveness of an MRI Try Without sedation program to decrease the wait time for obtaining an MRI while simultaneously ensuring diagnostic-quality images. MATERIALS AND METHODS A retrospective chart review was performed on subjects who utilized the MRI Try Without program from April 2014 through June 2015 at a dedicated pediatric institution. Child life specialist preparations and access time (i.e. time from exam ordered to exam completed) were recorded in each patient's electronic medical record. MRI images were evaluated for image quality by a pediatric neuroradiologist. RESULTS A total of 134 patients participated in the MRI Try Without program (mean age: 6.9±1.7 years), all of whom received interventions from a child life specialist. The average number of days between when the order was placed and when the MRI was completed using the MRI Try Without program was 15.4±18.5 days, while the third-available appointment for sedation/anesthesia was 46.2 days (standard deviation [SD]±15.7 days). Nearly all patients received a "good" or "very good" image quality determination (87.3%) and only 5 (3.8%) patients were recommended for repeat examination for diagnostic-quality images. CONCLUSION Utilization of an MRI Try Without sedation program, with child life specialist interventions, decreased the wait time for obtaining an MRI while still providing diagnostic-quality images.
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Affiliation(s)
- Barbra S Rudder
- Child Life Department, Children's Mercy, 2401 Gillham Road, Kansas City, MO, 64108, USA.
| | - Sara J Easley
- Child Life Department, Children's Mercy, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Amie L Robinson
- Department of Radiology, Children's Mercy, Kansas City, MO, USA
| | | | - David B Nielsen
- Department of Radiology, Children's Mercy, Kansas City, MO, USA
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50
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Maknojia S, Churchill NW, Schweizer TA, Graham SJ. Resting State fMRI: Going Through the Motions. Front Neurosci 2019; 13:825. [PMID: 31456656 PMCID: PMC6700228 DOI: 10.3389/fnins.2019.00825] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/23/2019] [Indexed: 11/19/2022] Open
Abstract
Resting state functional magnetic resonance imaging (rs-fMRI) has become an indispensable tool in neuroscience research. Despite this, rs-fMRI signals are easily contaminated by artifacts arising from movement of the head during data collection. The artifacts can be problematic even for motions on the millimeter scale, with complex spatiotemporal properties that can lead to substantial errors in functional connectivity estimates. Effective correction methods must be employed, therefore, to distinguish true functional networks from motion-related noise. Research over the last three decades has produced numerous correction methods, many of which must be applied in combination to achieve satisfactory data quality. Subject instruction, training, and mild restraints are helpful at the outset, but usually insufficient. Improvements come from applying multiple motion correction algorithms retrospectively after rs-fMRI data are collected, although residual artifacts can still remain in cases of elevated motion, which are especially prevalent in patient populations. Although not commonly adopted at present, “real-time” correction methods are emerging that can be combined with retrospective methods and that promise better correction and increased rs-fMRI signal sensitivity. While the search for the ideal motion correction protocol continues, rs-fMRI research will benefit from good disclosure practices, such as: (1) reporting motion-related quality control metrics to provide better comparison between studies; and (2) including motion covariates in group-level analyses to limit the extent of motion-related confounds when studying group differences.
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Affiliation(s)
- Sanam Maknojia
- Physical Sciences Platform, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Nathan W Churchill
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Tom A Schweizer
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada.,Division of Neurosurgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Institute of Biomaterials and Biomedical Engineering, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - S J Graham
- Physical Sciences Platform, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Medical Biophysics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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