Magnetic resonance imaging in children: common problems and possible solutions for lung and airways imaging

Abstract

Pediatric chest MRI is challenging. High-resolution scans of the lungs and airways are compromised by long imaging times, low lung proton density and motion. Low signal is a problem of normal lung. Lung abnormalities commonly cause increased signal intenstities. Among the most important factors for a successful MRI is patient cooperation, so the long acquisition times make patient preparation crucial. Children usually have problems with long breath-holds and with the concept of quiet breathing. Young children are even more challenging because of higher cardiac and respiratory rates giving motion blurring. For these reasons, CT has often been preferred over MRI for chest pediatric imaging. Despite its drawbacks, MRI also has advantages over CT, which justifies its further development and clinical use. The most important advantage is the absence of ionizing radiation, which allows frequent scanning for short- and long-term follow-up studies of chronic diseases. Moreover, MRI allows assessment of functional aspects of the chest, such as lung perfusion and ventilation, or airways and diaphragm mechanics. In this review, we describe the most common MRI acquisition techniques on the verge of clinical translation, their problems and the possible solutions to make chest MRI feasible in children.

Free‐breathing pediatric chest MRI: Performance of self‐navigated golden‐angle ordered conical ultrashort echo time acquisition

“…Achieving diagnostic‐quality chest magnetic resonance imaging (MRI) has long been an important goal in pediatric imaging. Currently, when chest radiographs are insufficient, patients typically undergo computed tomography (CT) . While CT benefits from rapid acquisition, technical simplicity, and generally adequate visualization, there are several important drawbacks.…”

“…Most important is the exposure to ionizing radiation, which poses greater risk at younger age . This risk is further compounded by the frequent need for long‐term serial follow‐up imaging in children with chronic diseases such as cystic fibrosis (CF) . In contrast, MRI is ionizing radiation‐free.…”

Diagnosis and early life risk factors for bronchiectasis in cystic fibrosis: a review

“…Concerns also exist over the adequacy of current methods to calculate the radiation dose received [66]. To overcome the concerns around ionizing radiation researchers are turning to magnetic resonance imaging (MRI) to detect and follow structural lung disease in CF [64,[67][68][69][70]. While the features of CF structural lung disease can be detected in young children [70], the resolution of current MRI remains problematic.…”

Early lung surveillance of cystic fibrosis: what have we learnt?

“…Novel measures of airway geometry and lung density show promise in objectively measuring lung disease but need further validation [21]. While lung magnetic resonance imaging is being explored in the context of CF lung disease, it is technically challenging in young children and infants [22] and has not entered routine research or clinical practice in infants and young children with CF. Due to these limitations, CT scans, using age-appropriate outcomes, are ideally suited for both early disease surveillance and determining the efficacy of prophylactic treatments to prevent the onset and progression of structural lung disease in young children.…”