Case Series: Pediatric GOBrain-5-Minute Protocol MR Imaging at 3 Tesla

Courtesy: Elka Miller, M.D., FRCPC¹; Barry Smith, MRT (MR)², Medical Imaging Department, Children’s Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada|2019-04-02

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Background: Fast-brain MRI was first introduced for children3 with shunt dependent hydrocephalus [1-3] who frequently undertake serial imaging studies through life. In young patients, MRI studies might require sedation or general anesthesia, which have their own risks of complications [4]. Therefore, fast MRI sequences can avoid the need for sedation or anesthesia, and are thus particularly useful for young and uncooperative patients. Recently, fast MRI sequences have become more popular and are increasingly being used for non-hydrocephalic indications such as macrocephaly, intracranial cysts, screening for some structural congenital and non-congenital anomalies, and postoperative follow-up [5].

GOBrain [6, 7] was developed as a 5-minute diagnostic brain exam and was clinically validated to be diagnostically equivalent to the longer, conventional exam. The 5-minute examination provides the basic clinical sequences including sagittal T1w, axial T2w, axial T2 TSE FLAIR, axial DWI, and axial T2*-weighted sequences. Several factors, like parallel imaging with higher acceleration factors, gradient T1-weighted and EPI-GRE T2*-weighted acquisitions, have made it possible to shorten the scan time but have also alleviated EPI-related susceptibility artifacts and image distortions by reducing the EPI-factors and shortened the inter-echo spacing. The hope is that the 5-minute protocol will reach high diagnostic concordance for the diagnosis of clinically relevant findings compared to the conventional protocol, and therefore become useful in a selected group of pediatric patients that are more prone to motion and the need for anesthesia.

The case report shows parameters and scan time for 5-minute GObrian MRI protocols.
Table 1: Acquisition parameters and scan time for 5-minute GOBrain MRI protocols on the MAGNETOM Skyra with the Head/Neck 20 coil.

Materials and Methods: All images in this case series were acquired on a 3T MAGNETOM Skyra scanner. The MRI protocol typically included the routine scan as per the radiologist’s request and the additional GOBrain-5-minute sequence appended to the end of the examination (Table 1).

Conclusion: Pediatric fast imaging techniques can shorten scan times, decrease motion-related artifacts, and have been shown to reduce the need for sedation [1]. In addition, they have the potential to reach diagnostic concordance of clinically relevant findings compared to the conventional protocol and therefore become useful in a selected group of pediatric patients that are more prone for motion and need of anesthesia. Improved patient throughput which decreases wait time can also be an advantage of this protocol.

Acknowledgement: We would like to acknowledge Ms. Wendy Rabbie MRT (R), Director Medical Imaging and Laboratory Medicine.

The first case report includes a 10-year-old female with severe traumatic brain injury.

Case 1
10-year-old female with severe traumatic brain injury. Top row GOBrain (2A–D: Sagittal T1w, axial T2 TSE, axial T2 FSE FLAIR, and axial T2*) obtained 3 days after the conventional MRI. Bottom row, routine sequences (2E–H: Sagittal T1w, axial T2w, axial FLAIR, and susceptibility-weighted imaging (SWI)). Findings consistent with brain contusion in the posterior parieto-occipital cerebral hemispheres and subdural bleed along the left tentorium (arrow). There is comparable conspicuity of the contusion and blood products with the routine and the GOBrain-5-minute protocol.

The second case report shows the treatment of a 7-year-old female, with suprasellar germinoma treated with chemotherapy and radiation.

Case 2
7-year-old female, suprasellar germinoma treated with chemotherapy and radiation. 4A, B: baseline images before treatment. Top row GOBrain (4C, D: axial T2 TSE, and axial T2 TSE FLAIR). Bottom row, routine sequences (4E, F: axial T2w, and axial FLAIR) follow-up 2 years after treatment. The follow-up images exemplify the comparable image quality of the suprasellar residual lesion in the GOBrain-5-minute protocol (top row), compared to the conventional protocol (bottom row). Follow-up images using GOBrain and conventional protocols were obtained the same day.

The third case report shows a 10-year-old male, with a 2 week history of morning headaches and waking up at night.

Case 3
10-year-old male, 2 week history of morning headaches, waking up at night. History of anxiety. Suspected radiological isolated demyelinating type lesions. Top row GOBrain (5A, B: axial T2 TSE, and axial T2 TSE FLAIR). Bottom row, conventional sequences (5C, D: axial T2w, and axial FLAIR). The images exemplify the same number and size of white matter lesions (arrows) in the GOBrain-5-minute protocol (top row), compared to the conventional protocol (bottom row).
 

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