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      Real-time MRI: a new tool of radiologic imaging in small children


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          Real-time MRI (rt-MRI) in children is a new imaging technique that combines the advantages of US — at frame rates of up to 50 images per second — with the quality and features of MRI. Although still subject of research, it has become a standard tool in the diagnostic portfolio of two pediatric radiology departments in Germany. Based on ultrashort acquisition times, any detrimental effects of macroscopic movements of the child and the physiological movements of the organs are negligible. Especially in pediatric brain imaging, rt-MRI has already proven its value. With suitable indications, rt-MRI can reduce anesthesia and sedation examinations in children below 6 years of age by 40% due to its very short examination time and its robustness to motion. There is a high level of acceptance among parents and referrers when diagnostic possibilities and limitations are communicated correctly.

          Conclusion: Completely new diagnostic possibilities arise in the imaging of the moving lung, the beating heart, joint movements, and speaking and swallowing, as demonstrated in this video-backed review.

          What is known:

          MRI in moving children has been burdened with severe artifacts.

          Gross motion usually has to be handled by sedation and periodic motion of the heart and lungs has to be compensated with time-consuming techniques until now.

          What is new:

          Real-time MRI allows image acquisition with up to 50 frames per second similar to ultrasound frame rate.

          Real-time MRI proofs to be very promising for imaging children, reducing examination time and sedation rate drastically.

          Supplementary Information

          The online version contains supplementary material available at 10.1007/s00431-023-04996-0.

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          Most cited references26

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          Real-time MRI at a resolution of 20 ms.

          The desire to visualize noninvasively physiological processes at high temporal resolution has been a driving force for the development of MRI since its inception in 1973. In this article, we describe a unique method for real-time MRI that reduces image acquisition times to only 20 ms. Although approaching the ultimate limit of MRI technology, the method yields high image quality in terms of spatial resolution, signal-to-noise ratio and the absence of artifacts. As proposed previously, a fast low-angle shot (FLASH) gradient-echo MRI technique (which allows for rapid and continuous image acquisitions) is combined with a radial encoding scheme (which offers motion robustness and moderate tolerance to data undersampling) and, most importantly, an iterative image reconstruction by regularized nonlinear inversion (which exploits the advantages of parallel imaging with multiple receiver coils). In this article, the extension of regularization and filtering to the temporal domain exploits consistencies in successive data acquisitions and thereby enhances the degree of radial undersampling in a hitherto unexpected manner by one order of magnitude. The results obtained for turbulent flow, human speech production and human heart function demonstrate considerable potential for real-time MRI studies of dynamic processes in a wide range of scientific and clinical settings. Copyright © 2010 John Wiley & Sons, Ltd.
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            Real-Time Magnetic Resonance Imaging: Radial Gradient-Echo Sequences With Nonlinear Inverse Reconstruction.

            The aim of this study is to evaluate a real-time magnetic resonance imaging (MRI) method that not only promises high spatiotemporal resolution but also practical robustness in a wide range of scientific and clinical applications.
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              Real-time magnetic resonance imaging of cardiac function and flow-recent progress.

              Cardiac structure, function and flow are most commonly studied by ultrasound, X-ray and magnetic resonance imaging (MRI) techniques. However, cardiovascular MRI is hitherto limited to electrocardiogram (ECG)-synchronized acquisitions and therefore often results in compromised quality for patients with arrhythmias or inabilities to comply with requested protocols-especially with breath-holding. Recent advances in the development of novel real-time MRI techniques now offer dynamic imaging of the heart and major vessels with high spatial and temporal resolution, so that examinations may be performed without the need for ECG synchronization and during free breathing. This article provides an overview of technical achievements, physiological validations, preliminary patient studies and translational aspects for a future clinical scenario of cardiovascular MRI in real time.

                Author and article information

                Eur J Pediatr
                Eur J Pediatr
                European Journal of Pediatrics
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                30 May 2023
                30 May 2023
                : 182
                : 8
                : 3405-3417
                [1 ]GRID grid.411339.d, ISNI 0000 0000 8517 9062, Department of Pediatric Radiology, , University Hospital, ; Leipzig, Germany
                [2 ]GRID grid.516369.e, Biomedical NMR, , Max Planck Institute for Multidisciplinary Sciences, ; Gottingen, Germany
                [3 ]GRID grid.14778.3d, ISNI 0000 0000 8922 7789, Department of Radiology, , University Hospital, ; Dusseldorf, Germany
                [4 ]GRID grid.411339.d, ISNI 0000 0000 8517 9062, Department of Pediatrics, , University Hospital, ; Leipzig, Germany
                [5 ]GRID grid.411339.d, ISNI 0000 0000 8517 9062, Department of Neurosurgery, , University Hospital, ; Leipzig, Germany
                [6 ]GRID grid.411339.d, ISNI 0000 0000 8517 9062, Department of Pediatrics Surgery, , University Hospital, ; Leipzig, Germany
                Author notes

                Communicated by Peter de Winter.

                © The Author(s) 2023, corrected publication 2023

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                : 26 March 2023
                : 19 April 2023
                : 20 April 2023
                Funded by: European Society of Paediatric Radiology
                Award ID: Guy Sebag Grant 2019
                Award Recipient :
                Funded by: Universität Leipzig (1039)
                Custom metadata
                © Springer-Verlag GmbH Germany, part of Springer Nature 2023

                magnetic resonance imaging,anesthesiologists,workflow,radiology,pediatric radiology
                magnetic resonance imaging, anesthesiologists, workflow, radiology, pediatric radiology


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