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Published on: January 7, 2019
A retrospective comparison of image quality in T2-weighted paediatric brain MRI using Children- centred Care versus
K Brage1, G B Villadsen2, D S Heglingegård3
1Education of Radiography, UCL University College, 5230, Odense M, Denmark; Health Sciences Research Centre, UCL University College, 5230, Odense M, Denmark; Institute of Clinical Research, Research and Innovation Unit of Radiology, University of Southern Denmark, Odense, Denmark.
Insights
General anaesthesia (GA) for paediatric brain MRI resulted in superior image quality compared to the Children-centred Care (CCC) approach. However, CCC images were mostly clinically acceptable, indicating a viable alternative to GA for paediatric MRI.
Area of Science:
- Medical imaging
- Paediatric radiology
- Neuroimaging
Background:
- Magnetic Resonance Imaging (MRI) is crucial for paediatric brain condition evaluation due to excellent soft tissue contrast and no ionizing radiation.
- General anaesthesia (GA) is often required for paediatric MRI to minimize motion artifacts, increasing wait times and costs.
- The Children-centred Care (CCC) approach aims to reduce GA dependency, but its effect on image quality needs scientific assessment.
Purpose of the Study:
- To scientifically evaluate the impact of the Children-centred Care (CCC) approach on paediatric brain MRI image quality compared to MRI performed under General Anaesthesia (GA).
- To compare image quality between paediatric brain MRIs performed with and without GA using a structured Visual Grading Analysis (VGA).
Main Methods:
- Retrospective cohort study of children aged 3-6 years undergoing brain MRI.
- Image quality assessed using Visual Grading Analysis (VGA) on T2-weighted MRIs by three independent observers.
- Statistical analysis employed the Mann-Whitney U test; observer agreement assessed using Cohen's and Fleiss' kappa tests.
Main Results:
- Children undergoing MRI with GA (n=22) showed significantly higher image quality scores (mean VGA 4.32) than those in the CCC group (n=48, mean VGA 3.71).
- Intra-observer reliability was substantial to perfect (κw = 0.64-0.84), while inter-observer agreement was fair (κ = 0.32).
- Slice thickness was slightly thinner in the GA group (p < 0.001).
Conclusions:
- Paediatric brain MRI under GA demonstrated superior T2-weighted image quality compared to the CCC approach.
- Despite lower scores, most CCC images were clinically acceptable, supporting its feasibility as a patient-centered alternative to reduce GA use, risks, and costs.
- Visual Grading Analysis (VGA) offers a structured method for assessing paediatric brain MRI quality, potentially aiding in standardizing criteria.
Introduction:
Magnetic Resonance Imaging (MRI) is the preferred modality for evaluating paediatric brain conditions due to its superior soft tissue contrast and absence of ionising radiation. However, children often require general anaesthesia (GA) to prevent motion artefacts, leading to increased waiting times and costs. The Children-centred Care (CCC) approach reduces the need for GA, but its potential impact on image quality has not been scientifically evaluated.
Methods:
This retrospective cohort study included children aged 3-6 years who underwent brain MRI with or without GA in a clinical setting. Three observers performed a Visual Grading Analysis (VGA) to assess image quality on T2-weighted MRIs. The Mann-Whitney U test was used for statistical analysis, and intra- and inter-observer agreement was evaluated using Cohen's and Fleiss' kappa tests.
Results:
A total of 70 brain MRIs from 68 children were included, with 22 in the GA group and 48 in the CCC group. Image quality scores were significantly higher in the GA group (mean VGA 4.32 vs. 3.71, p < 0.001). Intra-observer reliability ranged from substantial to perfect (κw = 0.64-0.84), and inter-observer agreement was fair (κ = 0.32). Slice thickness differed slightly with thinnest slices in the GA group (p < 0.001).
Conclusion:
T2-weighted paediatric brain MRI under GA showed superior image quality compared to CCC. However, most CCC images were clinically acceptable, suggesting focus on balancing image quality with GA avoidance. Future studies are warranted.
Implications For Practice:
VGA provides a structured approach to assessing image quality and could form the basis for developing standardised paediatric brain MRI criteria. These findings support CCC as a feasible, patient-centred alternative that reduces anaesthesia use, risks and costs, while enhancing the overall patient experience.
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