Article made by dr. Radu Nicolaescu specialist in radiology and medical imaging, specialized in pediatric imaging.

Magnetic resonance imaging (MRI) is a non-invasive test used to diagnose medical conditions.MRI is using a device with a circular tunnel in the middle to take pictures of the body. A strong magnetic field, radio frequencys and a computer are used to produce specialized images in two and three dimensions of your child’s body, without using radiation. MRI for children is versatile and is especially useful for seeing tissues and organs anywhere in the body, which otherwise can only be seen through operations such as:

  • blood vessels;
  • bone marrow;
  • brain;
  • muscles, ligaments, tendons and cartilage;
  • spine;

Young and very anxious children cannot remain motionless during the examination and therefore need sedation / anesthesia. In our center, we offer the full range of MRI services, performed non-invasively, without sedation / anesthesia services, for children 6 years and older.

 What are the common indications of the procedure?

MRI is used to help diagnose a wide range of conditions in children due to trauma, disease or birth defects. MRI is able to tell differentiate diseased tissue from normal tissue better than radiography, CT and ultrasound.

When imaging a child’s brain and spinal cord is needed, this investigation is useful because of its ability to “see” through the bones of the skull and spine without radiation. MRI of the brain and spine is used, among other things to:

  • Detect a variety of brain conditions and abnormalities such as cysts, tumors, bleeding, edema or blood vessel problems;;
  • Detect brain damage caused by trauma or cerebral ischemia;
  • To diagnose infectious or autoimmune diseases such as encephalopathy or encephalitis;
  • Assess problems such as persistent headaches, dizziness, weakness, blurred vision, or seizures;
  • Helps in the detection of certain chronic diseases of the nervous system, such as multiple sclerosis;
  • Diagnosis of pituitary gland problems and assessment of the cause of developmental delay;
  • Assessment of degeneration of the spine and vertebral discs (including hernias);
  • Evaluation of spine bones for congenital or acquired abnormalities;
  • Determine the condition of the nerve tissue in the spinal cord;

In some cases, specialized sequences are required, such as MRI Spectroscopy, Tensor Diffusion Imaging (ITD), or MRI Perfusion. For our pediatric patients, if necessary, these sequences are added to the basic imaging protocol at no additional cost. However, the duration of the exam will increase (by 15 to 30 minutes more).

For the heart, MRI is often used in a complementary role to echocardiography (cardiac ultrasound), computed tomography, and cardiac catheterization to provide information both before and after treatment. Cardiac MRI can be used for:

  • Assessment of the structure of the heart and surrounding blood vessels;
  • Evaluation of the causes of arrhythmia (abnormal heart rhythm);
  • Assessment of heart infections;
  • Control following cardiovascular surgery.

In the abdominal and pelvic region, MRI is used to:

  • diagnosis and monitoring of infectious or inflammatory conditions (eg inflammatory bowel disease such as Crohn’s disease, in which Entero-MR examination is indicated);
  • assessment of malformations (eg renal malformations assessed by Uro-MR);
  • diagnosis of oncological diseases and monitoring the response to treatment;

MRI is often the best choice for joint and bone imaging, where it can help:

  • diagnosis of sports-related injuries or various injuries;
  • detection of tumors, bones or joints infection;
  • diagnosis of joint development abnormalities in children;

What does the MRI equipment look like?

The MRI unit is a device in the shape of a large cylinder (tube), surrounded by a circular magnet. Your child will lie on a mobile examination table that slides into the center of the magnet. The operator’s workstation, where he works to set up images is located in a separate room from the scanner. You can take a virtual tour of the clinic and the room where the device is located here.

 

How do I prepare my child for pediatric magnetic resonance imaging (MRI)?

Studies show that children and parents cope better with medical procedures when they are prepared in advance. We recommend that you talk to your child about what to expect before the scheduled investigation. Talking to the children a few days in advance allows them to process the information and ask any questions to better understand what to expect. Although the procedure is not painful, sometimes children feel anxious when they do not know what to expect or do something new for the first time. Therefore, we encourage a visit to the clinic before the appointment date, so that the child becomes familiar with the device, the environment and how the test will be conducted.

 

What are the instructions before pediatric magnetic resonance imaging (MRI)?

Be honest and give simple explanations about what is going to happen. Children need to know what they will see, feel and hear during the procedure.

See: When they enter the MRI room, they will see a large machine with a tunnel in the middle. This is the “photo camera”.

Feel: The MRI investigation doesn’t hurt. If the scan requires administration of the intravenous contrast agent, it will be necessary to fit an IV cannula (branula) before starting the scan.

Listen: The device is noisy (noise here)). You will hear various sounds and / or beats. However, he will receive headphones to listen to music, while reducing the sounds of the device.

Allow your child to ask questions about their future experience. If you don’t know how to answer your child’s questions, it’s a good idea to say “I don’t know.” Our team is always available to answer any questions your child may have. If they do not want to know about the procedure, do not force a discussion and do not overwhelm them with information.

Practice creates perfection! It is very important for your child to stay still during the pictures. Create a game that encourages the child to practice standing still. Set a timer for 2 minutes and gradually increase the time to 5-6 minutes. It can be difficult to stand still on the day of the appointment without any prior practice.

Your child may be asked to wear a special robe during the exam or may be allowed to wear their own clothes as long as they are not too wide and do not have metallic elements. Jewelry and other accessories should be left at home if possible or removed before MRI scanning. Because they can be a danger to the safety of your child, metal and electronic items are not allowed in the examination room. These elements include:

  • jewelry, watches, credit cards and hearing aids;
  • needles, hairpins, metal zippers and similar metal objects;
  • removable dental work;
  • pens and spectacles(eye glasses);
  • piercings.

Food and hydration recommendations before the MRI examination vary depending on the specific examination. Unless you are told otherwise, it is advisable not to eat 4 hours before the exam. Hydration can be done normally.

Your radiologist, operator or nurse will ask if your child has allergies of any kind, such as an allergy to iodine or contrast agents, medicines, food or the environment, or if your child has asthma.

Even if the scheduled examination is a native one (without contrast agent), the radiologist may consider it appropriate to administer it according to the images obtained during the examination. Therefore, it is useful to have blood tests of renal function (creatinine and urea), not older than six months. If your child has a history of kidney disease, you will need to have a blood test (performed on the spot) to determine if the kidneys are working properly.

Also tell your doctor about any recent illnesses or other medical conditions that your child may have. Bring all of your child’s medical records and previous exams (interpretation and CD).

Tell your healthcare provider if your child has implanted medical or electronic devices. These objects may interfere with the examination or present a risk, depending on their nature. Many implanted devices will have a brochure explaining the risks of MRI for that device. If you have the package leaflet, it is useful to bring it to the attention of the operator before the exam. Examples include, but are not limited to:

  • Cochlear implant (ear);
  • Clips used for cerebral aneurysms;
  • Metal coils placed in blood vessels;
  • Implanted heart defibrillators and pacemakers;
  • Artificial heart valves;
  • Implanted drug infusion ports;
  • Articulated metal prostheses;
  • Implanted nerve stimulators;
  • Metal rods, screws, plates, stents or surgical staples.

You must notify your operator or radiologist of any chips, bullets or other metal parts that may be present in your child’s body due to previous accidents. Foreign bodies close to the eyes are especially important. Dental braces are made of many types of materials. Most are not usually affected by the magnetic field, but can distort images of the facial area or brain. Therefore, it is necessary to ask your child’s orthodontist for a list of materials that are part of the dental appliance. Sometimes it may be necessary to disassemble parts of the appliance or the entire appliance.

Anyone accompanying a patient to the examination room will be asked about the existence of metal objects and similarly implanted devices.

What can I expect before a pediatric magnetic resonance imaging (MRI) exam?

Once you arrive at the clinic, a team member will take you to our training area. We will complete the pre-procedural assessments, screening forms and your child will change into a special robe. Some exams require contrast administration. It is administered orally or intravenously through the branula, depending on the type of study required. If a branula mount is needed, we will do this before starting the MRI scan. Certain types of examination require special training. For example, for an Entero-MR exam, your child will need to drink a solution of water and mannitol (a type of sugar solution) for 30-45 minutes before the actual exam (you will receive specific instructions from the team if applicable, at the time of scheduling).

For your child’s own examination, the MRI operator will help your child position himself on the table of the device depending on the type of scan required. While most children are positioned on their backs, some scans require them to lie on their stomachs or sides, with their head or feet facing the device. Fastening methods such as textile straps or various supports can be used to help the child stay still and maintain the correct position while acquiring images. Devices that detect radio waves emitted by the patient (antennas) will be placed around or near the area of the scanned body.

The MRI machine looks like an open tunnel at both ends, and the examination table moves through that tunnel opening. The scan is noisy, so your child will receive headphones to attenuate some of the noise. Once your child is comfortable on the table, a red light will come on to help align his or her body to the correct position for scanning. Your child will then be moved to the MRI scanner tunnel.

How is the procedure performed?

After the operator leaves the scan room, the exam will begin. The operator continues to monitor the child throughout the scan and is able to talk to him between acquisition sequences.

MRI scans generally include several sequences, some of which may take a few minutes. The entire procedure can take from 30 minutes to an hour for each part of the body examined. Your child will need to stay as still as possible during the scan. Motion during scanning can lead to difficult-to-interpret images for radiologists.

If a contrast agent is used during the examination, it will be injected through the branula after an initial series of scans. More images will be taken during or after the injection.

To help your child stay still, he or she will have the option to listen to music while scanning. Also, a child can bring a small comfort element in the scanner to help them feel safe (plush animal, blanket, etc.). However, it must not contain any metal and will be checked for safety before inserting it into the magnet chamber.

We value the presence and support of parents during the proceedings. A parent / guardian may be present during the exam to remind the child to stay calm and help him or her stay calm.

To participate with your child in the magnet room, you will need to fill out an MRI screening form on the day of the appointment.

 

What will my child experience during and after the procedure?

Your child will not feel any pain during the exam. Some children do not like the sound of the device and the small space inside the MRI tunnel. During the exam, children will receive headphones, through which music can be played. The device is well air-conditioned and lighted, and the tube is open at both ends.

It is normal for the assessed area of your child’s body to slightly warm up.

There is a two-way communication system through which your child can communicate with the operator between sequences. In addition, there is an alarm system through which your child can request assistance at any time. In some cases, intravenous administration of the contrast agent may be performed. Branula can cause discomfort to your child when inserted and he/she may have a bruise. There is also a very small chance of skin irritation at the site of the branula insertion.

No recovery period is required, and your child can resume normal activities and a normal diet immediately after the exam. Some patients experience side effects from the contrast material, including nausea and local pain. Very rarely, patients are allergic to it and have hives, redness of the eyes or other reactions. If your child has allergic symptoms, a radiologist or other doctor will be available for immediate assistance.

 

What are the benefits and risks of a pediatric MRI (MRI) assessment?

Benefits:

  • MRI is a non-invasive imaging technique that does not involve exposure to radiation;
  • MRI imaging of the body’s soft tissue structures – such as the heart, liver, and many other organs – is more effective in some cases in accurately identifying and characterizing certain conditions than in other imaging methods. This detail makes MRI an invaluable tool in the early diagnosis and evaluation of many focal lesions and tumors;
  • MRI has proven valuable in diagnosing a wide range of conditions, including cancer, heart and vascular disease, muscle and bone abnormalities;
  • MRI provides a noninvasive alternative to radiography, angiography, and CT to diagnose heart and blood vessel problems;
  • The contrast agent (gadolinium-based) used by MRI is less likely to cause an allergic reaction than the iodine-based contrast agents used for CT scans.

Risks:

  • The MRI examination presents almost no risk for most patients when the safety instructions are followed;
  • Although the strong magnetic field is not harmful, implanted medical devices that contain metal can malfunction or cause problems during an MRI examination;
  • Nephrogenic systemic fibrosis is currently a recognized but rare complication that is thought to be caused by injection of the gadolinium-based contrast agent in patients with very poor renal function. Detecting renal dysfunction before considering contrast injection minimizes the risk of this very rare complication;
  • There is a very low risk of an allergic reaction if a contrast agent is injected. Such reactions are usually mild and easily controlled by drugs. If you have allergic symptoms, a radiologist or other doctor will be available for immediate assistance;
  • Small amounts of gadolinium contrast agent may remain in the patient’s body, including the brain. Gadolinium retention has not been shown to harm patients with normal kidney function, and the benefit of an accurate diagnosis far outweighs any potential risk.

 

What are the MRI limitations for children (pediatrics)?

High quality images are provided only if your child is able to remain perfectly still and follow the breathing instructions while the images are being recorded. If your child is restless, confused or in severe pain, it will be difficult to stand still during the picture. In this situation it is necessary to examine with sedation / anesthesia. At this time, sedation / anesthesia examinations cannot be performed at the Emerald Center.

A person who is very large may not fit into the opening of certain types of MRI devices. The presence of an implant or other metal object sometimes makes it difficult to obtain clear images. The patient’s movement can have the same effect.

Very irregular heartbeats can affect the quality of images obtained using techniques synchronized with the electrical activity of the heart (EKG).

 

Who reads the results and how do we get them?

A radiologist, a doctor trained and licensed to supervise and interpret MRI tests for children, will analyze the images. It will issue a signed report that will be directed to you and, upon request, to your clinician. For each case, a prior evaluation of the indication is required, our team requesting before scheduling the documents from the consultation that recommended the investigation through the Republic of Moldova. Details, appointments and more information at 0739675688 .

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