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Chest examinations in children with real-time magnetic resonance imaging: first clinical experience
Franz Wolfgang Hirsch1, Ina Sorge2, Dirk Voit3
1Department of Pediatric Radiology, University Hospital, Liebigstraße 20a, 04107, Leipzig, Germany. franzwolfgang.hirsch@medizin.uni-leipzig.de.
Background:
Real-time magnetic resonance imaging (MRI) based on a fast low-angle shot technique 2.0 (FLASH 2.0) is highly effective against artifacts caused due to the bulk and pulmonary and cardiac motions of the patient. However, to date, there are no reports on the application of this innovative technique to pediatric lung MRI.
Objective:
This study aimed to identify the limits of resolution and image quality of real-time lung MRI in children and to assess the types and minimal size of lesions with these new sequences.
Materials And Methods:
In this retrospective study, pathological lung findings in 87 children were classified into 6 subgroups, as detected on conventional MRI: metastases and tumors, consolidation, scars, hyperinflation, interstitial pathology and bronchiectasis. Subsequently, the findings were grouped according to size (4-6 mm, 7-9 mm and ≥ 10 mm) and evaluated for visual delineation of the findings (0 = not visible, 1 = hardly visible and 2 = well visualized).
Results:
Real-time MRI allows for diagnostic, artifact-free thorax images to be obtained, regardless of patient movements. The delineation of findings strongly correlates with the size of the pathology. Metastases, consolidation and scars were visible at 100% when larger than 9 mm. In the 7-9 mm subgroup, the visibility was 83% for metastases, 88% for consolidation and 100% for scars in T2/T1 weighting. Though often visible, smaller pathological lesions of 4-6 mm in size did not regularly meet the expected diagnostic confidence: The visibility of metastases was 18%, consolidation was 64% and scars was 71%. Diffuse interstitial lung changes and hyperinflation, known as "MR-minus pathologies," were not accessible to real-time MRI.
Conclusion:
The method provides motion robust images of the lung and thorax. However, the lower sensitivity for small lung lesions is a major limitation for routine use of this technique. Currently, the method is adequate for diagnosing inflammatory lung diseases, atelectasis, effusions and lung scarring in children with irregular breathing patterns or bulk motion on sedation-free MRI. A medium-term goal is to improve the diagnostic accuracy of small nodules and interstitial lesions.
Insights
Real-time MRI offers artifact-free pediatric lung imaging, effectively detecting larger lesions. However, its sensitivity for small lung pathologies remains a limitation for widespread clinical use.
Area of Science:
- Radiology
- Pediatric Imaging
- Medical Technology
Background:
- Real-time magnetic resonance imaging (MRI) using fast low-angle shot (FLASH 2.0) technique minimizes motion artifacts in thoracic imaging.
- Application of FLASH 2.0 for pediatric lung MRI has not been previously reported.
Purpose of the Study:
- To evaluate the resolution limits and image quality of real-time pediatric lung MRI.
- To determine the minimum lesion size and types detectable with this technique in children.
Main Methods:
- Retrospective analysis of pathological lung findings in 87 children using conventional MRI.
- Classification of findings into 6 subgroups and assessment of visibility based on size (4-6 mm, 7-9 mm, ≥10 mm).
Main Results:
- Real-time MRI produced diagnostic, motion-free thoracic images.
- Lesion visibility strongly correlated with size: >9 mm lesions were 100% visible.
- Smaller lesions (4-6 mm) showed variable visibility (18-71%), with interstitial changes and hyperinflation not detected.
Conclusions:
- Real-time MRI provides motion-robust pediatric lung imaging, suitable for inflammatory diseases, scarring, and effusions.
- Limited sensitivity for small lung lesions hinders routine application; further improvements are needed for nodule and interstitial lesion detection.
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