title: [Dispensing with sedation in pediatric MR imaging of the brain: what is feasible?].
abstract: OBJECTIVE
  Feasibility study to evaluate whether a diagnostic pediatric MRI scan of the brain can be performed without sedation by using BLADE sequences with rotating blade-like k-space covering.
  
  
  METHODS
  Between 01/09 and 12/10 all children with a planned MRI of the brain were included. After age-dependent preparation of the child the MRI was acquired with a parent closely attending. Pharmacological sedation was only applied when strong motion artifacts occurred. All MRI sequences were independently reviewed by 2 radiologists who ranked image quality on a scale of III (excellent image quality, no motion artefacts), II (motion artefacts but still diagnostic quality), and I (non-diagnostic image quality).
  
  
  RESULTS
  326 children (53 % male, mean age 7.2 ± 4.3 years) were evaluated of whom 247 (76 %) had to be sedated. All infants < 1 year and 84 % of 1-year-old patients, 90 % of 2-year-old, 59 % of 3-year-old, 9 % of 4-year-old children, and 2 % of patients older than 4 years had to be sedated. In total, 2461 MRI sequences (7.6 ± 1.2 per study) including 622 BLADE sequences (25 %) were acquired. Reviewer A rated 2077 sequences (84 %) as III, 318 (13 %) as II, and 66 (3 %) as I, whereas reviewer B rated 2119 sequences (86 %) as III, 308 (13 %) as II, and 34 (1 %) as I. Inter-observer agreement was good to excellent (normal/weighted kappa value for BLADE sequences: 0.88/0.56, for all sequences: 0.92/0.71).
  
  
  CONCLUSIONS
  Age-adjusted preparation and implementation of a pediatric cranial MRI may reduce the need for sedation. BLADE sequences abate motion artefacts thus enabling acquisition of diagnostic images even in young children. In patients older than 3 years, performance of MRI scans without sedation should be considered.
authors.affiliation: Institut für Diagnostische Radiologie, Interventionelle Radiologie und Nuklearmedizin, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany. christoph.heyer@rub.de
authors.forename: C M
authors.initials: CM
authors.lastname: Heyer
authors.forename: S P
authors.initials: SP
authors.lastname: Lemburg
authors.forename: S
authors.initials: S
authors.lastname: Sterl
authors.forename: T
authors.initials: T
authors.lastname: Holland-Letz
authors.forename: V
authors.initials: V
authors.lastname: Nicolas
mesh_terms: D000367:Age Factors; D016477:Artifacts; D001921:Brain / Q000473:pathology*; D001927:Brain Diseases / Q000175:diagnosis*; D001930:Brain Injuries / Q000175:diagnosis*; D001932:Brain Neoplasms / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D016292:Procedural Sedation; D005240:Feasibility Studies; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011446:Prospective Studies; D012680:Sensitivity and Specificity