High success rates of sedation-free brain MRI scanning in young children using simple subject preparation protocols with and without a commercial mock scanner–the Diabetes Research in Children Network (DirecNet) experience
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The ability to lie still in an MRI scanner is essential for obtaining usable image data. To reduce motion, young children are often sedated, adding significant cost and risk.
We assessed the feasibility of using a simple and affordable behavioral desensitization program to yield high-quality brain MRI scans in sedation-free children.
Materials and methods
222 children (4–9.9 years), 147 with type 1 diabetes and 75 age-matched non-diabetic controls, participated in a multi-site study focused on effects of type 1 diabetes on the developing brain. T1-weighted and diffusion-weighted imaging (DWI) MRI scans were performed. All children underwent behavioral training and practice MRI sessions using either a commercial MRI simulator or an inexpensive mock scanner consisting of a toy tunnel, vibrating mat, and video player to simulate the sounds and feel of the MRI scanner.
205 children (92.3%), mean age 7 ± 1.7 years had high-quality T1-W scans and 174 (78.4%) had high-quality diffusion-weighted scans after the first scan session. With a second scan session, success rates were 100% and 92.5% for T1-and diffusion-weighted scans, respectively. Success rates did not differ between children with type 1 diabetes and children without diabetes, or between centers using a commercial MRI scan simulator and those using the inexpensive mock scanner.
Behavioral training can lead to a high success rate for obtaining high-quality T1-and diffusion-weighted brain images from a young population without sedation.
KeywordsMRI Diffusion-weighted imaging Sedation-free Sedation Mock scanner Behavioral preparation Children Diabetes
The authors are grateful to the DirecNet study coordinators and research assistants for the recruitment, training and care of all children in the study, and to the radiology technologists who performed these scans. This research was supported by funding from Jaeb Center for Health Research and the National Institutes of Health (DIRECNET U01 HD41890, HD41890-10, HD41906-10, HD41908-10, HD41915, HD41918, HD56526) and UL1 RR024992. The DirecNet Study Group consists of the following groups and individuals (personnel are listed as PI for principal investigator, I for co-investigator and C for coordinators):
Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, IA—Eva Tsalikian, MD (PI); Michael J. Tansey, MD (I); Julie Coffey, MSN (C); Joanne Cabbage (C); Sara Salamati (C).
Nemours Children’s Clinic, Jacksonville, FL—Nelly Mauras, MD (PI); Larry A. Fox, MD (I); Allison Cato, PhD (I); Kim Englert, RN, BSN, CDE (C); Kaitlin Sikes, ARNP, MSN (C); Tina Ewen (C).
Division of Pediatric Endocrinology and Diabetes, Stanford University, Stanford, CA—Bruce A. Buckingham, MD (PI); Darrell M. Wilson, MD (I); Tandy Aye, MD (I); Kimberly Caswell, ARNP (C).
Department of Pediatrics, Yale University School of Medicine, New Haven, CT—Stuart A. Weinzimer, MD (PI); William V. Tamborlane, MD (I); Amy Steffen, BS (C); Kate Weyman, MSN (C); Melinda Zgorski, BSN (C).
Washington University in St. Louis, St. Louis, MO—Neil H. White, MD, CDE (PI); Ana Maria Arbelaez, MD, (I); Lucy Levandoski, PA-C (C); Angie Starnes, RN, BSN, CDE (C), Tamara Hershey, PhD (I).
Coordinating Center, Jaeb Center for Health Research, Tampa, FL—Roy W. Beck, MD, PhD; Katrina J. Ruedy, MSPH; Craig Kollman, PhD; Peiyao Cheng, MPH; Beth Stevens.
Image Coordinating Center, Center for Interdisciplinary Brain Sciences Research at Stanford University—Allan L. Reiss, MD; Naama Barnea-Goraly, MD; Matthew J. Marzelli, BS; Paul M. Mazaika, PhD.
Conflicts of interest
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