Feasibility of Non-Sedate Magnetic Resonance Imaging for Children with Cerebral Palsy: Tolerance and Structural...

Background/Objectives: Non-sedate magnetic resonance imaging (MRI) can be challenging for young children with neuromotor disabilities, often resulting in motion-degraded images that complicate interpretation in the context of underlying neuropathology. This study aimed to characterize tolerance factors and barriers related to awake MRI of the pediatric brain and to examine additional considerations in analyzing structural scans affected by motion and pathology. Methods: 10 children (mean age 5y9m; 5 girls; GMFCS level IV) with cerebral palsy (CP) underwent non-sedate 3T MRI of the brain. Tolerance factors and challenges were documented. MRI quality and automated structural preprocessing with Freesurfer (FS) v.8.0 were reviewed by a pediatric neuroradiologist and neurologist. To assess the impact of motion, automated basal ganglia segmentation was compared with manual segmentation. Segmentation accuracy was characterized using Dice Coefficient (D). Results: Five participants (50%) tolerated non-sedate structural MRI, although two of them were unable to remain still. Factors affecting MRI tolerance included sensitivity to scanner noise (n = 4), hyperkinetic movement (n = 2), difficulty with positioning/padding (n = 4), fear of clinical environment (n = 2) or confined scanner interior (n = 2), and earbud discomfort (n = 3). Automated structural preprocessing with FS yielded discrepancies in gray-white matter boundaries in motion-degraded scans, necessitating manual correction. Automated segmentation of motion-compromised scans closely agreed with manual delineation of the caudate (D ≥ 0.85) and putamen (D ≥ 0.78), while the pallidum was least reproducible (D = 0.58). Conclusions: Tailored acquisition and processing strategies are necessary to support non-sedate MRI in children with CP, preserve downstream neuroimaging analyses, and promote inclusion of underrepresented populations in research.