Brief Report: Approaches to 31P-MRS in Awake, Non-Sedated Children with and without Autism Spectrum Disorder

Abstract

We piloted a suite of approaches aimed to facilitate a successful series of up to four brain and muscle 31Phosphorus-Magnetic Resonance Spectroscopy (31P-MRS) scans performed in one session in 12 awake, non-sedated subjects (ages 6 – 18), 6 with autism spectrum disorders (ASD) and 6 controls. We targeted advanced preparation, parental input, physical comfort, short scan protocols, allocation of extra time, and subject emotional support. 100% of subjects completed at least one brain scan and one leg muscle scan: 42 of 46 attempted scans were completed (91%), with failures dominated by exercise muscle scans (completed in 6/6 controls but 3/6 cases). One completed scan lacked usable data unrelated to subject/scan procedure (orthodonture affected a frontal brain scan). As a group, these methods provide a foundation for conduct and enhancement of future MR studies in pediatric subjects with ASD.

A systematic review of person-centred adjustments to facilitate magnetic resonance imaging for autistic patients without the use of sedation or anaesthesia

“…Two studies investigated autistic adults ( Hayes, 2018 ; Smith et al, 2019 ). Thirteen of the included studies recruited only autistic children ( Cox et al, 2017 ; DeMayo et al, 2021 ; Dosenbach et al, 2017 ; Erickson et al, 2012 ; Gabrielsen et al, 2018 ; Horien et al, 2020 ; Kecskemeti et al, 2018 ; Netzke-Doyle, 2010 ; Nordahl et al, 2016 ; Pua et al, 2020 ; Sandbank & Cascio, 2019 ; Tziraki et al, 2021 ; Yamada et al, 2020 ). In addition to children, parents were also recruited in three of the included studies ( Johnson & Bree, 2014 ; Johnson et al, 2014 , 2017 ).…”

“…Optimisation of communication was found to be vital for an autism-friendly MRI service. Specifically, contacting autistic individuals and their parents/carers prior to the examination to provide customised patient care before the MRI scan was widely seen as useful practice ( Berglund et al, 2017 ; DeMayo et al, 2021 ; Erickson et al, 2012 ; Nordahl et al, 2016 ; Björkman et al, 2017 ; Pua et al, 2020 ; Tziraki et al, 2021 ; Yamada et al, 2020 ), as was encouraging radiographers to wear staff ID cards to help patients with face–name associations ( Pua et al, 2020 ). Also, pre-scan interviews with autistic children and their parents play an important role in pre-MRI communication ( Gabrielsen et al, 2018 ).…”

“…Also, pre-scan interviews with autistic children and their parents play an important role in pre-MRI communication ( Gabrielsen et al, 2018 ). Sending information letters or flyers prior to the scan also allowed patients to familiarise with the examination and its requirements and encouraged them to ask questions ( Erickson et al, 2012 ). The implementation of a flowchart with visual cues to guide the patient through the procedure has also been recommended ( DeMayo et al, 2021 ; Pua et al, 2020 ).…”

Assessing Bioenergetic Compromise in Autism Spectrum Disorder With 31P Magnetic Resonance Spectroscopy

“…For participants able to complete the exercise protocol, a spectrum was collected every 3 seconds during 2 minutes of rest (providing resting muscle spectra), then 5 minutes of exercise (repetitively pushing a pedal, similar to depressing a car pedal) and 6 minutes of recovery. Resting muscle spectra were secured for participants unable to follow the exercise protocol 20 .…”

“…A range of other approaches to foster successful awake, nonsedated scanning were used and have been reported elsewhere 20 .…”