Pulmonary MRI of neonates in the intensive care unit using 3D ultrashort echo time and a small footprint MRI system

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Abstract

<div class="section"> <a class="named-anchor" id="S1">  </a> <h5 class="section-title" id="d102153e228">Purpose</h5> <p id="P1">To determine feasibility of pulmonary MRI of neonatal lung structures enabled by combining two novel technologies: first, a 3D radial ultrashort echo time (UTE) pulse sequence capable of high spatial resolution full-chest imaging in non-sedated quiet-breathing neonates, and second, a unique, small-footprint 1.5T MRI scanner design adapted for neonatal imaging and installed within the Neonatal Intensive Care Unit (NICU). </p> </div><div class="section"> <a class="named-anchor" id="S2">  </a> <h5 class="section-title" id="d102153e233">Materials and Methods</h5> <p id="P2">Ten patients underwent MRI within the NICU, in accordance with an approved Institutional Review Board protocol. Five had clinical diagnoses of bronchopulmonary dysplasia (BPD), and five had putatively normal lung function. Pulmonary imaging was performed at 1.5T using 3D radial UTE and standard 3D fast gradient recalled echo (FGRE). Diagnostic quality, presence of motion artifacts, and apparent severity of lung pathology were evaluated by two radiologists. Quantitative metrics were additionally used to evaluate lung parenchymal signal. </p> </div><div class="section"> <a class="named-anchor" id="S3">  </a> <h5 class="section-title" id="d102153e238">Results</h5> <p id="P3">UTE images showed significantly higher signal in lung parenchyma (p <0.0001) and fewer apparent motion artifacts compared to FGRE (p = 0.046). Pulmonary pathology was more severe in patients diagnosed with BPD relative to controls (p = 0.001). Infants diagnosed with BPD also had significantly higher signal in lung parenchyma, measured using UTE, relative to controls (p = 0.002). </p> </div><div class="section"> <a class="named-anchor" id="S4">  </a> <h5 class="section-title" id="d102153e243">Conclusion</h5> <p id="P4">These results demonstrate the technical feasibility of pulmonary MRI in free-breathing, non-sedated infants in the NICU at high, isotropic resolutions approaching that achievable with CT. There is potential for pulmonary MRI to play a role in improving how clinicians understand and manage care of neonatal and pediatric pulmonary diseases. </p> </div>

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Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study

Mark S. Pearce, Jane Salotti, Mark Little … (2012)

Summary Background Although CT scans are very useful clinically, potential cancer risks exist from associated ionising radiation, in particular for children who are more radiosensitive than adults. We aimed to assess the excess risk of leukaemia and brain tumours after CT scans in a cohort of children and young adults. Methods In our retrospective cohort study, we included patients without previous cancer diagnoses who were first examined with CT in National Health Service (NHS) centres in England, Wales, or Scotland (Great Britain) between 1985 and 2002, when they were younger than 22 years of age. We obtained data for cancer incidence, mortality, and loss to follow-up from the NHS Central Registry from Jan 1, 1985, to Dec 31, 2008. We estimated absorbed brain and red bone marrow doses per CT scan in mGy and assessed excess incidence of leukaemia and brain tumours cancer with Poisson relative risk models. To avoid inclusion of CT scans related to cancer diagnosis, follow-up for leukaemia began 2 years after the first CT and for brain tumours 5 years after the first CT. Findings During follow-up, 74 of 178 604 patients were diagnosed with leukaemia and 135 of 176 587 patients were diagnosed with brain tumours. We noted a positive association between radiation dose from CT scans and leukaemia (excess relative risk [ERR] per mGy 0·036, 95% CI 0·005–0·120; p=0·0097) and brain tumours (0·023, 0·010–0·049; p<0·0001). Compared with patients who received a dose of less than 5 mGy, the relative risk of leukaemia for patients who received a cumulative dose of at least 30 mGy (mean dose 51·13 mGy) was 3·18 (95% CI 1·46–6·94) and the relative risk of brain cancer for patients who received a cumulative dose of 50–74 mGy (mean dose 60·42 mGy) was 2·82 (1·33–6·03). Interpretation Use of CT scans in children to deliver cumulative doses of about 50 mGy might almost triple the risk of leukaemia and doses of about 60 mGy might triple the risk of brain cancer. Because these cancers are relatively rare, the cumulative absolute risks are small: in the 10 years after the first scan for patients younger than 10 years, one excess case of leukaemia and one excess case of brain tumour per 10 000 head CT scans is estimated to occur. Nevertheless, although clinical benefits should outweigh the small absolute risks, radiation doses from CT scans ought to be kept as low as possible and alternative procedures, which do not involve ionising radiation, should be considered if appropriate. Funding US National Cancer Institute and UK Department of Health.

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Estimated risks of radiation-induced fatal cancer from pediatric CT.

D. Brenner, C Elliston, E. Hall … (2001)

In light of the rapidly increasing frequency of pediatric CT examinations, the purpose of our study was to assess the lifetime cancer mortality risks attributable to radiation from pediatric CT. Organ doses as a function of age-at-diagnosis were estimated for common CT examinations, and estimated attributable lifetime cancer mortality risks (per unit dose) for different organ sites were applied. Standard models that assume a linear extrapolation of risks from intermediate to low doses were applied. On the basis of current standard practice, the same exposures (milliampere-seconds) were assumed, independent of age. The larger doses and increased lifetime radiation risks in children produce a sharp increase, relative to adults, in estimated risk from CT. Estimated lifetime cancer mortality risks attributable to the radiation exposure from a CT in a 1-year-old are 0.18% (abdominal) and 0.07% (head)-an order of magnitude higher than for adults-although those figures still represent a small increase in cancer mortality over the natrual background rate. In the United States, of approximately 600,000 abdominal and head CT examinations annually performed in children under the age of 15 years, a rough estimate is that 500 of these individuals might ultimately die from cancer attributable to the CT radiation. The best available risk estimates suggest that pediatric CT will result in significantly increased lifetime radiation risk over adult CT, both because of the increased dose per milliampere-second, and the increased lifetime risk per unit dose. Lower milliampere-second settings can be used for children without significant loss of information. Although the risk-benefit balance is still strongly tilted toward benefit, because the frequency of pediatric CT examinations is rapidly increasing, estimates that quantitative lifetime radiation risks for children undergoing CT are not negligible may stimulate more active reduction of CT exposure settings in pediatric patients.

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Selection of a convolution function for Fourier inversion using gridding [computerised tomography application].

J.I Jackson, C.H. Meyer, D.G. Nishimura … (1991)

In the technique known as gridding, the data samples are weighted for sampling density and convolved with a finite kernel, then resampled on a grid preparatory to a fast Fourier transform. The authors compare the artifact introduced into the image for various convolving functions of different sizes, including the Kaiser-Bessel window and the zero-order prolate spheroidal wave function (PSWF). They also show a convolving function that improves upon the PSWF in some circumstances.

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Author and article information

Journal

Title: Journal of Magnetic Resonance Imaging

Abbreviated Title: J. Magn. Reson. Imaging

Publisher: Wiley

ISSN: 10531807

Publication date Created: February 2017

Publication date (Print): February 2017

Publication date (Electronic): July 26 2016

Volume: 45

Issue: 2

Pages: 463-471

Affiliations

[1 ]Department of Medical Physics; University of Wisconsin; Madison Wisconsin USA

[2 ]Center for Pulmonary Imaging Research, Division of Pulmonary Medicine and Department of Radiology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio USA

[3 ]Department of Physics; Washington University in St. Louis; St. Louis Missouri USA

[4 ]Department of Physics; University of Cincinnati; Cincinnati Ohio USA

[5 ]Perinatal Institute, Division of Neonatology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio USA

[6 ]Imaging Research Center, Department of Radiology; Cincinnati Children's Hospital Medical Center; Cincinnati Ohio USA