Pediatric Radiology

, Volume 42, Issue 10, pp 1223–1228 | Cite as

The impact of preparation and support procedures for children with sickle cell disease undergoing MRI

  • Katherine R. Cejda
  • Matthew P. Smeltzer
  • Eileen N. Hansbury
  • Mary Elizabeth McCarville
  • Kathleen J. Helton
  • Jane S. Hankins
Original Article



Children with sickle cell disease (SCD) often undergo MRI studies to assess brain injury or to quantify hepatic iron. MRI requires the child to lie motionless for 30–60 min, thus sedation/anesthesia might be used to facilitate successful completion of exams, but this poses additional risks for SCD patients. To improve children’s ability to cope with MRI examinations and avoid sedation, our institution established preparation and support procedures (PSP).


To investigate the impact of PSP in reducing the need for sedation during MRI exams among children with SCD.

Materials and methods

Data on successful completion of MRI testing were compared among 5- to 12-year-olds who underwent brain MRI or liver R2*MRI with or without receiving PSP.


Seventy-one children with SCD (median age 9.85 years, range 5.57–12.99 years) underwent a brain MRI (n = 60) or liver R2*MRI (n = 11). Children who received PSP were more likely to complete an interpretable MRI exam than those who did not (30 of 33; 91% vs. 27 of 38; 71%, unadjusted OR = 4.1 (P = 0.04) and OR = 8.5 (P < 0.01) when adjusting for age.


PSP can help young children with SCD complete clinically interpretable, nonsedated MRI exams, avoiding the risks of sedation/anesthesia.


Sickle cell anemia Sedation MRI MRA Child life specialist Preparation and support procedure Children 


  1. 1.
    Ohene-Frempong K, Weiner SJ, Sleeper LA et al (1998) Cerebrovascular accidents in sickle cell disease: rates and risk factors. Blood 91:288–294PubMedGoogle Scholar
  2. 2.
    Pegelow CH, Wang W, Granger S et al (2001) Silent infarcts in children with sickle cell anemia and abnormal cerebral artery velocity. Arch Neurol 58:2017–2021PubMedCrossRefGoogle Scholar
  3. 3.
    Powars D, Wilson B, Imbus C et al (1978) The natural history of stroke in sickle cell disease. Am J Med 65:461–471PubMedCrossRefGoogle Scholar
  4. 4.
    Balkaran B, Char G, Morris JS et al (1992) Stroke in a cohort of patients with homozygous sickle cell disease. J Pediatr 120:360–366PubMedCrossRefGoogle Scholar
  5. 5.
    Adams RJ, McKie VC, Hsu L et al (1998) Prevention of a first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial Doppler ultrasonography. N Engl J Med 339:5–11PubMedCrossRefGoogle Scholar
  6. 6.
    Adams RJ, McKie VC, Brambilla D et al (1998) Stroke prevention trial in sickle cell anemia. Control Clin Trials 19:110–129PubMedCrossRefGoogle Scholar
  7. 7.
    Kugler S, Anderson B, Cross D et al (1993) Abnormal cranial magnetic resonance imaging scans in sickle-cell disease. Neurological correlates and clinical implications. Arch Neurol 50:629–635PubMedCrossRefGoogle Scholar
  8. 8.
    Olivieri NF (2001) Progression of iron overload in sickle cell disease. Semin Hematol 38:57–62PubMedCrossRefGoogle Scholar
  9. 9.
    Jordan LC, McKinstry RC III, Kraut MA et al (2010) Incidental findings on brain magnetic resonance imaging of children with sickle cell disease. Pediatrics 126:53–61PubMedCrossRefGoogle Scholar
  10. 10.
    Hulbert ML, McKinstry RC, Lacey JL et al (2011) Silent cerebral infarcts occur despite regular blood transfusion therapy after first strokes in children with sickle cell disease. Blood 117:772–779PubMedCrossRefGoogle Scholar
  11. 11.
    Hankins JS, McCarville MB, Loeffler RB et al (2009) R2* magnetic resonance imaging of the liver in patients with iron overload. Blood 113:4853–4855PubMedCrossRefGoogle Scholar
  12. 12.
    St Pierre TG, Clark PR, Chua-Anusorn W et al (2005) Noninvasive measurement and imaging of liver iron concentrations using proton magnetic resonance. Blood 105:855–861PubMedCrossRefGoogle Scholar
  13. 13.
    Koshy M, Weiner SJ, Miller ST et al (1995) Surgery and anesthesia in sickle cell disease. Cooperative study of sickle cell diseases. Blood 86:3676–3684PubMedGoogle Scholar
  14. 14.
    Holzmann L, Finn H, Lichtman HC et al (1969) Anesthesia in patients with sickle cell disease: a review of 112 cases. Anesth Analg 48:566–572PubMedCrossRefGoogle Scholar
  15. 15.
    Oduro KA, Searle JF (1972) Anaesthesia in sickle-cell states: a plea for simplicity. Br Med J 4:596–598PubMedCrossRefGoogle Scholar
  16. 16.
    Child Life Council Inc. (2011) Child life: empowering children and families. Accessed 27 April 2012
  17. 17.
    Vichinsky EP, Haberkern CM, Neumayr L et al (1995) A comparison of conservative and aggressive transfusion regimens in the perioperative management of sickle cell disease. The Preoperative Transfusion in Sickle Cell Disease Study Group. N Engl J Med 333:206–213PubMedCrossRefGoogle Scholar
  18. 18.
    Vichinsky EP, Neumayr LD, Haberkern C et al (1999) The perioperative complication rate of orthopedic surgery in sickle cell disease: report of the National Sickle Cell Surgery Study Group. Am J Hematol 62:129–138PubMedCrossRefGoogle Scholar
  19. 19.
    Josephson CD, Su LL, Hillyer KL et al (2007) Transfusion in the patient with sickle cell disease: a critical review of the literature and transfusion guidelines. Transfus Med Rev 21:118–133PubMedCrossRefGoogle Scholar
  20. 20.
    Buck J, Davies SC (2005) Surgery in sickle cell disease. Hematol Oncol Clin North Am 19:897–902, viiPubMedCrossRefGoogle Scholar
  21. 21.
    Edwards AD, Arthurs OJ (2011) Paediatric MRI under sedation: is it necessary? What is the evidence for the alternatives? Pediatr Radiol 41:1353–1364PubMedCrossRefGoogle Scholar
  22. 22.
    Raschle NM, Lee M, Buechler R et al (2009) Making MR imaging child's play—pediatric neuroimaging protocol, guidelines and procedure. J Vis Exp 29:pii1309Google Scholar
  23. 23.
    Carter AJ, Greer ML, Gray SE et al (2010) Mock MRI: reducing the need for anaesthesia in children. Pediatr Radiol 40:1368–1374PubMedCrossRefGoogle Scholar
  24. 24.
    Carbajal R, Lenclen R, Gajdos V et al (2002) Crossover trial of analgesic efficacy of glucose and pacifier in very preterm neonates during subcutaneous injections. Pediatrics 110:389–393PubMedCrossRefGoogle Scholar
  25. 25.
    Shields CH, Johnson S, Knoll J et al (2004) Sleep deprivation for pediatric sedated procedures: not worth the effort. Pediatrics 113:1204–1208PubMedCrossRefGoogle Scholar
  26. 26.
    Kazak AE, Penati B, Brophy P et al (1998) Pharmacologic and psychologic interventions for procedural pain. Pediatrics 102:59–66PubMedCrossRefGoogle Scholar
  27. 27.
    Hallowell LM, Stewart SE, de Amorim E et al (2008) Reviewing the process of preparing children for MRI. Pediatr Radiol 38:271–279PubMedCrossRefGoogle Scholar
  28. 28.
    Khan JJ, Donnelly LF, Koch BL (2007) A program to decrease the need for pediatric sedation for CT and MRI. Appl Radiol 4:30–33Google Scholar
  29. 29.
    Pressdee D, May L, Eastman E et al (1997) The use of play therapy in the preparation of children undergoing MR imaging. Clin Radiol 52:945–947PubMedCrossRefGoogle Scholar
  30. 30.
    Smart G (1997) Helping children relax during magnetic resonance imaging. MCN Am J Matern Child Nurs 22:236–241PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Katherine R. Cejda
    • 1
  • Matthew P. Smeltzer
    • 2
  • Eileen N. Hansbury
    • 3
  • Mary Elizabeth McCarville
    • 5
  • Kathleen J. Helton
    • 5
  • Jane S. Hankins
    • 4
  1. 1.Child Life ProgramSt. Jude Children’s Research HospitalMemphisUSA
  2. 2.Department of BiostatisticsSt. Jude Children’s Research HospitalMemphisUSA
  3. 3.Baylor International Hematology Center of Excellence and the Texas Children’s Center for Global HealthHoustonUSA
  4. 4.Department of HematologySt. Jude Children’s Research HospitalMemphisUSA
  5. 5.Department of Radiological SciencesSt. Jude Children’s Research HospitalMemphisUSA

Personalised recommendations