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Diagnostic equivalency of fast T2 and FLAIR sequences for pediatric brain MRI: a pilot study
Camilo Jaimes1,2,3, Edward Yang1,2, Pauline Connaughton4
1Division of Pediatric Neuroradiology, Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02215, USA.
Background:
Faster and motion robust magnetic resonance imaging (MRI) sequences are desirable in pediatric brain MRI as they can help reduce the need for monitored anesthesia care, which is a costly and limited resource that carries medical risks.
Objective:
To evaluate the diagnostic equivalency of commercially available accelerated motion robust MR sequences relative to standard sequences.
Materials And Methods:
This was an institutional review board-approved prospective study. Subjects underwent a clinical brain MRI using conventional multiplanar images at 3 Tesla followed by fast axial T2 and FLAIR (fluid-attenuated inversion recovery) sequences optimized for an approximately 50% reduction in acquisition time. Conventional and fast images from each subject were reviewed by two blinded pediatric neuroradiologists. The readers evaluated the presence of 12 findings. Intra-observer agreement was estimated for fast versus conventional sequences. For each set of sequences, interobserver agreement calculations and chi-square tests were used to evaluate differences between fast and conventional acquisitions. An independent third reader reviewed the intra-observer discrepancies and adjudicated them as being more conspicuous on fast sequence, conventional sequence or the equivalent. The readers also were asked to rate motion artifacts with a previously validated score.
Results:
Images from 77 children (mean age: 11.3 years) were analyzed. Intra-observer agreement (fast versus conventional) ranged between 89.2% and 92.3%. Interobserver agreement ranged between 86.1% and 88.4%. Interobserver agreement was significantly higher for conventional FLAIR relative to fast FLAIR for small (<5 mm) foci of T2 in the white matter. Otherwise, interobserver agreement was not different between the fast and conventional sequences. For awake subjects, fast sequences had significantly fewer artifacts (P<0.05).
Conclusion:
Conventional T2 and FLAIR sequences can be optimized to shorten acquisition while maintaining diagnostic equivalency. These faster sequences were also less susceptible to motion artifacts.
Insights
Faster magnetic resonance imaging (MRI) sequences in pediatric brain scans maintain diagnostic accuracy while reducing motion artifacts. These advanced MRI techniques can decrease the need for anesthesia, improving safety and resource allocation.
Area of Science:
- Radiology
- Medical Imaging
Background:
- Pediatric brain MRI requires faster, motion-robust sequences to minimize anesthesia use.
- Anesthesia in pediatric imaging is resource-intensive and carries risks.
Purpose of the Study:
- To assess the diagnostic equivalence of accelerated, motion-robust MRI sequences compared to standard ones.
- Evaluate the performance of fast T2 and FLAIR sequences in pediatric brain imaging.
Main Methods:
- Prospective study involving 77 children undergoing 3 Tesla MRI.
- Comparison of conventional and accelerated fast T2 and FLAIR sequences by blinded pediatric neuroradiologists.
- Analysis of diagnostic findings, inter- and intra-observer agreement, and motion artifacts.
Main Results:
- Fast sequences showed high intra- and inter-observer agreement, comparable to conventional sequences.
- Interobserver agreement was slightly lower for fast FLAIR in detecting small white matter foci.
- Fast sequences demonstrated significantly fewer motion artifacts, especially in awake children.
Conclusions:
- Optimized conventional T2 and FLAIR sequences can be accelerated to reduce scan time without compromising diagnostic value.
- Faster MRI sequences are a viable alternative, offering reduced motion and potentially lowering the need for anesthesia in pediatric brain imaging.
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