Paul Cawley^1,2, Francesco Padormo^1,3, UNITY Consortium⁴, Louise Dillon¹, Emer Hughes¹, Jennifer Almalbis¹, Joanna Robinson^1,2, Alessandra Maggioni^1,2, Daniel Cromb^1,2, Lori Arlinghaus⁵, Houchun Harry Hu⁵, Steve Williams⁴, Serena Counsell¹, Tomoki Arichi¹, Mary Rutherford¹, Joseph V. Hajnal¹, and A. David Edwards^1,2
1Centre for the Developing Brain, King's College London, London, United Kingdom, ²Neonatal Intensive Care Unit, Guy's & St Thomas' Hospital NHS Foundation Trust, London, United Kingdom, ³Medical Physics, Guy's & St Thomas' Hospital NHS Foundation Trust, London, United Kingdom, ⁴Centre for Neuroimaging Sciences, King's College London, London, United Kingdom, ⁵Hyperfine, Inc., Guildford, CT, United States

Point-of-care Magnetic Resonance scanning is a novel and potentially transformative technology, utilising Ultra-Low Field permanent magnets to facilitate bedside neuroimaging. Through iterative T2w sequence optimisation, we demonstrate the feasibility of using ultra-low field portable 64mT MR scanning in neonates. This pilot data demonstrates that images can provide sufficient contrast for tissue differentiation and identify pathological lesions. Scanning with ongoing intensive care was both feasible and safe.

Inge van Ooijen^1,2, Kim Annink¹, Jeroen Dudink¹, Thomas Alderliesten¹, Floris Groenendaal¹, Maria Luisa Tataranno¹, Maarten Lequin², Hans Hoogduin², Frederik Visser², Alexander Raaijmakers^2,3, Dennis Klomp², Evita Wiegers², Manon Benders¹, Jannie Wijnen², and Niek van der Aa^1
1Department of Neonatology, University Medical Center Utrecht, Utrecht, Netherlands, ²Department of Radiology, University Medical Center Utrecht, Utrecht, Netherlands, ³Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands

7T MRI in infants could improve cerebral diagnostic quality, but safety should be evaluated before standard use. In this study, twenty infants without respiratory support between term-equivalent age and 3 months corrected age, were scanned on 7T directly after 3T MRI. Vital signs (heart rate, oxygen saturation and respiratory rate), temperature (rectal, body and brain), COMFORT scale scores and adverse events were monitored throughout the process. None of these parameters changed around 7T MRI. Also, heart rate and temperature were not significantly different during 7T, when compared to 3T MRI. Therefore scanning infants at 7T appears to be safe. 

Axel Largent¹, Jonathan Murnick^1,2, Yuan-Chiao Lu¹, Kushal Kapse¹, Nicole Andersen¹, Todd Richmann¹, Josepheen De Asis-Cruz¹, Jessica Quistorff¹, Catherine Lopez¹, Nickie Andescavage^1,3, and Catherine Limperopoulos^1,2,4
1Department of Diagnostic Imaging and Radiology, Children’s National Hospital, Developing Brain Institute, Washington, DC, United States, ²Departments of Radiology and Pediatrics, George Washington University, Washington, DC, United States, ³Department of Neonatology, Children's National Hospital, Washington, DC, United States, ⁴Neurology School of Medicine and Health Sciences, George Washington University, 20010, DC, United States

Monitoring fetal brain development is crucial for early diagnosis of brain malformations and other congenital disorders. Standard methods to monitor brain maturation are mainly based on subjective and time-consuming visual analysis of the progression of sulcation. Our study proposed a Bayesian deep-learning method (DLM) for automatic assessment of fetal-gestational age (GA), and accurate and efficient identification of fetuses with abnormal brain development. Our Bayesian DLM showed excellent performance in predicted GA (mean-absolute-error = 0.928 weeks) and compared favorably with other state-of-the-art methods. This method may be used in clinical practice for monitoring fetal-brain development and early diagnosis of fetal brain malformations.

Yamin Arefeen¹, Borjan Gagoski^2,3, Berkin Bilgic^4,5, Ellen Grant^2,3, and Elfar Adalsteinsson^1,6,7
1Massachusetts Institute of Technology, Cambridge, MA, United States, ²Fetal-Neonatal Neuroimaging and Developmental Science Center, Boston Children’s Hospital, Boston, MA, United States, ³Harvard Medical School, Boston, MA, United States, ⁴Athinoula A. Martinos Center for Biomedical Imaging, Charlestown, MA, United States, ⁵Department of Radiology, Harvard Medical School, Boston, MA, United States, ⁶Harvard-MIT Health Sciences and Technology, Cambridge, MA, United States, ⁷Institute for Medical Engineering and Science, Cambridge, MA, United States

Fetal MRI utilizes Half-Fourier-acquisition-single-shot-turbo-spin-echo (HASTE) for motion robust imaging. However, specific-absorption-rate (SAR) constraints from the refocusing pulse train lengthens scan time and increases vulnerability to motion-induced artifacts. Variable refocusing flip angle (VFA) acquisitions improve efficiency, but may suffer from poor contrast-to-noise-ratios (CNR).  We propose an optimization technique for VFA that retains ~90% CNR with 2.5x SAR reduction.  Furthermore, we demonstrate the first application of wave-encoding in fetal MRI at R_in-plane = 3-fold prospectively under-sampled acquisitions.  Combining HASTE, VFA, and wave-encoding improves acquisition time with reduced repetition times and shorter echo-trains and could enable simultaneous-multislice acquisitions for further acceleration.

Dengrong Jiang¹, W. Christopher Golden², Aylin Tekes¹, Charlamaine Parkinson², Bruno Soares¹, Avner Meoded¹, Hanzhang Lu^1,3,4, Frances Northington², and Peiying Liu^1,5
1Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD, United States, ²Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States, ³Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States, ⁴F.M. Kirby Research Center for Functional Brain Imaging, Kennedy Krieger Research Institute, Baltimore, MD, United States, ⁵Department of Diagnostic Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, United States

Hypoxic-ischemic-encephalopathy (HIE) is the leading cause of neonatal mortality and severe neurological impairment in childhood. Quantification of cerebral oxygen-extraction-fraction (OEF) in neonates with HIE may provide valuable information to guide the treatment and predict clinical outcome. In this pilot study, we used a novel MRI technique, accelerated-T₂-relaxation-under-phase-contrast (aTRUPC), to measure regional OEF in neonates with HIE. We demonstrated a trend towards lower cortical OEF in HIE neonates compared to healthy controls. In addition, neonates with severer brain injury had lower cortical OEF. These findings suggest that regional OEF measurement may be useful in evaluating cerebral injuries in HIE.

Maria Yanez Lopez¹, Anthony N Price¹, Nicolaas AJ Puts², Emer J Hughes¹, Richard AE Edden³, Grainne M McAlonan², Tomoki Arichi¹, and Enrico De Vita^4
1Centre for the Developing Brain, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom, ²Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom, ³Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD, United States, ⁴Biomedical Engineering Department, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK, London, United Kingdom

We have performed the first simultaneous measurement of GABA+, Glx and GSH in the preterm brain. Our main findings show that GABA+ and Glx significantly increased with postmenstrual age in preterm neonates during the 31-45 week period. We additionally found that metabolites underpinning glutamate and GABA neurotransmission levels in preterm babies were significantly lower than normative neonatal values, even when measured at the term time equivalent timepoint. We also identified higher GABA+ and Glx in the thalamus compared with the cortex. Our findings provide further support for the application of edited MRS in neurodevelopment.

Minhui Ouyang^1,2, John Detre³, Jessica L Hyland¹, Kay Laura Sindabizera¹, Yun Peng⁴, J. Christopher Edgar^1,2, and Hao Huang^1,2
1Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, United States, ²Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States, ³Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States, ⁴Department of Radiology, Beijing Children’s Hospital, Capital Medical University, Beijing, China

Infancy is one of the most prominent times of daily energy expenditure across the lifespan. Here, using cutting-edge pCASL with high-resolution at isotropic 2.5mm and phase-contrast MRI, we delineated the developmental trajectory of the infant’s global and regional cerebral blood flow (rCBF) supporting the metabolic needs for brain development in 0-28months. Significant age-related CBF increases during infancy were better modeled with biphasic linear models, with break-point ages observed earlier in sensorimotor and auditory cortices and later in association cortices. The established population-averaged rCBF maps across infancy can serve as normative rCBF atlases for neuroscientific research or clinical care.  

Jens Krister Johansson¹, Kerstin Lagerstrand^2,3, Liz Ivarsson⁴, Pär-Arne Svensson⁴, Hanna Hebelka^1,4, and Stephan Maier^1,5
1Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, ²Medical radiation sciences, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden, ³Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden., Gothenburg, Sweden, ⁴Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden., Gothneburg, Sweden, ⁵Department of Radiology,, Brigham and Women's Hospital, Boston, MA, United States, Boston, MA, United States

This study demonstrates that DWI with MUSE and RPG correction significantly reduces the geometric distortions and results in increased overall image quality without altering ADC in a pediatric patient population, compared to single-shot EPI. This improvement was confirmed both through quantitative and qualitative analysis.

Stephanie Withey^1,2,3, Lesley MacPherson⁴, Adam Oates⁴, Stephen Powell³, Jan Novak^2,3,5, Laurence Abernethy⁶, Barry Pizer⁷, Richard Grundy⁸, Paul S. Morgan^8,9,10, Simon Bailey¹¹, Dipayan Mitra¹², Theodoros N. Arvanitis^2,13, Dorothee P. Auer^10,14,15, Shivaram Avula⁶, and Andrew C. Peet^2,3
1RRPPS, University of Birmingham NHS Foundation Trust, Birmingham, United Kingdom, ²Oncology, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom, ³Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom, ⁴Radiology, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom, ⁵Department of Psychology, Aston University, Birmingham, United Kingdom, ⁶Radiology, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom, ⁷Oncology, Alder Hey Children’s NHS Foundation Trust, Liverpool, United Kingdom, ⁸The Children’s Brain Tumour Research Centre, University of Nottingham, Nottingham, United Kingdom, ⁹Medical Physics, Nottingham University Hospitals, Nottingham, United Kingdom, ¹⁰Division of Clinical Neuroscience, University of Nottingham, Nottingham, United Kingdom, ¹¹Sir James Spence Institute of Child Health, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom, ¹²Neuroradiology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom, ¹³Institute of Digital Healthcare, University of Warwick, Coventry, United Kingdom, ¹⁴Nottingham University Hospitals Trust, Neuroradiology, Nottingham, United Kingdom, ¹⁵NIHR Nottingham Biomedical Research Centre, Nottingham, United Kingdom

Dynamic susceptibility (DSC-) MRI provides measures of relative cerebral blood volume (rCBV) in paediatric brain tumours. Correction of rCBV for the effects of contrast agent leakage can be done using post-processing techniques. Eighty-five patients with a range of paediatric brain tumours underwent DSC-MRI scans at 4 centres using variable protocols. Leakage-corrected and uncorrected DSC-MRI parameters were calculated and patients were followed up. Median DSC-MRI parameters significantly predicted overall survival.

Alexandra G. O'Neill¹, Brian A. Hargreaves², Karla Epperson², Bruce L. Daniel², and Christoph Leuze^2
1Mathematics, Manhattan College, Riverdale, NY, United States, ²Radiology, Stanford University, Stanford, CA, United States

For many patients, particularly pediatric patients, MRI exams can be intimidating primarily due to the confined space and loud noises. This can result in failed, non-diagnostic, or degraded exams at cost and even risk to the patient. We present a virtual reality application for mobile devices, such as mobile phones, of a Magnetic Resonance Imaging simulation and training software to serve as a tool for medical professionals to prepare children for MRI scans. Initial evaluations show promising results for reducing movement in test subjects and potential for reducing worry or anxiety among individuals preparing for MRI.

Sam Geuens¹, Sanne Nauts², Anas Abdelrazeq³, Michael Aertsen¹, Gunnar Buyse¹, Philippe Demaerel¹, Jurgen Lemiere¹, Jessica Nijs¹, Greet Pauwels⁴, Marlies Potoms⁵, Saini Privender², Kate Sauer⁴, Marie Sjölinger ⁶, Olov Ståhl⁶, Marlies Treunen⁷, Sofie Van Cauter^8,9, Leen Wouters^8,9, and Barbara Weyn^7
1University Hospitals Leuven, KU Leuven, Leuven, Belgium, ²Philips, Eindhoven, Netherlands, ³RWTH Aachen University, Aachen, Germany, ⁴AZ Sint-Jan Brugge, Brugge, Belgium, ⁵Jessa Ziekenhuis, Hasselt, Belgium, ⁶RISE, Stockholm, Sweden, ⁷KU Leuven, Leuven, Belgium, ⁸Ziekenhuis Oost-Limburg, Genk, Belgium, ⁹Center for Translational Psychological Research TRACE, Ziekenhuis Oost-Limburg, Genk, Belgium

Undergoing an awake MRI-scan can be very stressful for young children and bears the risk that image quality is poor due to motion artefacts.  Behavioral training by an experienced trainer has shown success in preparing children before a scan, however, this approach is costly and trainer dependent.  We have designed a mobile app to prepare children for an upcoming MRI-scan at home. This app was tested by 52 children in four different hospitals. First data show that children and parents appreciate the app very much and that learning goals can be reached with a digital application at home.