Nonsedated Magnetic Resonance Imaging for Visualization of the Velopharynx in the Pediatric Population

Background Non-sedated MRI is gaining traction in clinical settings for visualization of the velopharynx in children with velopharyngeal insufficiency. However, the behavioral adaptation and training aspects that are essential for successful pediatric MRI have received limited attention. Solution We outline a program of behavioral modifications combined with patient education and provider training that has led to high success rates for non-sedated velopharyngeal MRI in children.

Development and Validation of a Pediatric MRI-Based Perianal Crohn Disease (PEMPAC) Index—A Report from the ImageKids Study

Background As part of the prospective multicenter ImageKids study, we aimed to develop and validate the pediatric MRI-based perianal Crohn disease (PEMPAC) index. Methods Children with Crohn disease with any clinical perianal findings underwent pelvic magnetic resonance imaging at 21 sites globally. The site radiologist and 2 central radiologists provided a radiologist global assessment (RGA) on a 100 mm visual analog scale and scored the items selected by a Delphi group of 35 international radiologists and a review of the literature. Two weighted multivariable statistical models were constructed against the RGA. Results Eighty children underwent 95 pelvic magnetic resonance imaging scans; 64 were used for derivation and 31 for validation. The following items were included: fistula number, location, length and T2 hyperintensity; abscesses; rectal wall involvement; and fistula branching. The last 2 items had negative beta scores and thus were excluded in a contending basic model. In the validation cohort, the full and the basic models had the same strong correlation with the RGA (r = 0.75; P < 0.01) and with the adult Van Assche index (VAI; r = 0.93 and 0.92; P < 0.001). The correlation of the VAI with the RGA was similar (r = 0.77; P < 0.01). The 2 models and the VAI had a similar ability to differentiate remission from active disease (area under the receiver operating characteristic curve, 0.91-0.94). The PEMPAC index had good responsiveness to change (area under the receiver operating characteristic curve, 0.89; 95% confidence interval, 0.69-1.00). Conclusions Using a blended judgmental and mathematical approach, we developed and validated an index for quantifying the severity of perianal disease in children with CD. The adult VAI may also be used with confidence in children.

Association of MRI brain injury with outcome after pediatric out-of-hospital cardiac arrest

ObjectiveDetermine the association between the extent of diffusion restriction and T2/FLAIR injury on brain MRI and outcomes after pediatric out-of-hospital cardiac arrest (OHCA).MethodsDiffusion restriction and T2/FLAIR injury were described according to the pediatric MRI modification of the Alberta Stroke Program Early Computed Tomography Score for children from 2005 to 2013 who had an MRI within 14 days of OHCA. The primary outcome was unfavorable neurologic outcome defined as ≥1 change in PCPC from baseline resulting in a hospital discharge PCPC score 3, 4, 5, or 6. Patients with unfavorable outcomes were further categorized into alive with PCPC 3–5, dead due to withdrawal of life sustaining therapies for poor neurologic prognosis (WLST-neuro), or dead by neurologic criteria.ResultsWe evaluated MRI scans from 77 patients (median age 2.21 [IQR 0.44, 13.07] years) performed 4 [2, 6] days post-arrest. Patients with unfavorable outcomes had more extensive diffusion restriction (median 7 [4, 10.3] vs 0 [0, 0] regions, p < 0.001) and T2/FLAIR injury (5.5 [2.3, 8.2] vs 0 [0, 0.75] regions, p < 0.001) compared to patients with favorable outcomes. AUROC for the extent of diffusion restriction and unfavorable outcome was 0.96 (95% CI, 0.91, 0.99) and 0.92 (95% CI, 0.85, 0.97) for T2/FLAIR injury. There was no difference in extent of diffusion restriction between patients who were alive with an unfavorable outcome and patients who died from WLST-neuro (p = 0.11).ConclusionsMore extensive diffusion restriction and T2/FLAIR injury on the modsASPECTS score within the first 14 days after pediatric cardiac arrest was associated with unfavorable outcomes at hospital discharge.

TO EVALUATE SAFETY AND EFFECTIVENESS OF KETAMINE-PROPOFOL COMBINATION AND PROPOFOL ALONE IN DIAGNOSTIC RADIOLOGICAL PROCEDURES (MRI) IN PEDIATRIC PATIENTS.

Introduction: There is a growing need for magnetic resonance imaging (MRI) in children for accurate diagnosis and appropriate medical treatment. In recent times, small doses of ketamine have been used along with propofol for pediatric MRI sedation. Aims and objectives: to evaluate safety and effectiveness of Ketamine-propofol combination and propofol alone in diagnostic radiological procedures (MRI) in pediatric patients. Materials and methods: The present prospective randomized double blinded study was undertaken at Government General Hospital, Tirupati. Pediatric patients aged between 2 to 12 years of both sex, belonging to ASA grade I & II and posted for elective MRI Brain scan were included in the study. Results: KP group had significantly more reactions than P group. Recovery time (time taken to achieve modified aldrete recovery score of 9-10) was 37.33±2.88 min and 19.6±2.67 min in Ketofol group and propofol group respectively. Conclusion: Ketofol is an attractive combination for procedural sedation.