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Motion-corrected cardiac MRI is associated with decreased anesthesia exposure in children
Adam B Christopher1, Rachel E Quinn2, Sara Zoulfagharian1
1Division of Cardiology, Children's National Health System, 111 Michigan Avenue NW, Washington, DC, 20010, USA.
Background:
The benefits of cardiac magnetic resonance imaging (MRI) in the pediatric population must be balanced with the risk and cost of anesthesia. Segmented imaging using multiple averages attempts to avoid breath-holds requiring general anesthesia; however, cardiorespiratory artifacts and prolonged scan times limit its use. Thus, breath-held imaging with general anesthesia is used in many pediatric centers. The advent of free-breathing, motion-corrected (MOCO) cines by real-time re-binned reconstruction offers reduced anesthesia exposure without compromising image quality.
Objective:
This study evaluates sedation utilization in our pediatric cardiac MR practice before and after clinical introduction of free-breathing MOCO imaging for cine and late gadolinium enhancement.
Materials And Methods:
In a retrospective study, patients referred for a clinical cardiac MR who would typically be offered sedation for their scan (n=295) were identified and divided into two eras, those scanned before the introduction of MOCO cine and late gadolinium enhancement sequences and those scanned following their introduction. Anesthesia use was compared across eras and disease-specific cohorts.
Results:
The incidence of non-sedation studies performed in children nearly tripled following the introduction of MOCO imaging (25% [pre-MOCO] to 69% [post-MOCO], P<0.01), with the greatest effect in patients with simple congenital heart disease. Eleven percent of the post-MOCO cohort comprised infants younger than 3 months of age who could forgo sedation with the combination of MOCO imaging and a "feed-and-bundle" positioning technique.
Conclusion:
Implementation of cardiac MR with MOCO cine and late gadolinium enhancement imaging in a pediatric population is associated with significantly decreased sedation utilization.
Insights
Motion-corrected (MOCO) imaging significantly reduced the need for anesthesia in pediatric cardiac MRI scans. This advancement allows more children to undergo essential cardiac imaging without sedation, improving patient care.
Area of Science:
- Pediatric Cardiology
- Medical Imaging
- Anesthesiology
Background:
- Cardiac MRI in children often requires anesthesia, balancing benefits against risks and costs.
- Traditional methods to avoid anesthesia, like segmented imaging, have limitations.
- Free-breathing, motion-corrected (MOCO) imaging offers a potential solution to reduce anesthesia exposure.
Purpose of the Study:
- To evaluate the impact of free-breathing MOCO imaging on sedation utilization in pediatric cardiac MRI.
- To compare sedation rates before and after the clinical implementation of MOCO cine and late gadolinium enhancement.
Main Methods:
- Retrospective study of 295 pediatric patients undergoing cardiac MRI.
- Patients divided into pre-MOCO and post-MOCO eras.
- Comparison of anesthesia use across different eras and patient cohorts.
Main Results:
- Non-sedation studies nearly tripled post-MOCO implementation (25% to 69%).
- The most significant reduction in sedation was observed in patients with simple congenital heart disease.
- Infants under 3 months benefited greatly from MOCO imaging combined with positioning techniques, forgoing sedation.
Conclusions:
- Implementing MOCO cine and late gadolinium enhancement in pediatric cardiac MRI significantly decreases sedation rates.
- MOCO imaging enhances the feasibility of non-sedated cardiac MRI in pediatric patients.
- This technology improves the balance between diagnostic benefits and the risks/costs of anesthesia.
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