Feasibility and efficacy of low-field magnetic resonance imaging in critically unwell children: A developing country experience

A novel portable low-field MRI (pMRI) system has been recently developed and approved for use in different care settings. This study aims to describe the experience of using pMRI at the bedside in pediatric intensive care unit (PICU) of a developing country and evaluate its efficacy for diagnosing acute brain injury (ABI) in critically ill children compared to standard neuroimaging, conventional magnetic resonance imaging (cMRI) and computed tomography (CT) scan. In this prospective pilot cohort study, children admitted to PICU (aged 0–8 years), between May 2021 – June 2022, and underwent cMRI or CT scan brain were included. pMRI scans were performed within a 24-h window of standard neuroimaging, at the bedside, excluding clinically unstable and agitated children who required sedation. pMRI Images were transferred to online system for reporting by a trained pediatric radiologist, while standard neuroimaging was reported as per routine. The radiological results of both modalities were compared, and kappa-statistic computed to assess the level of agreement. A total 108 eligible patients were identified, 88 patients underwent pMRI within 24-h of standard neuroimaging, 85 (96·6%) patients completed scan and 73 were included in final analysis. One patient was agitated, one became unstable, and one required another therapeutic procedure so pMRI couldn't be completed. Mean age was 4·8 (±5.2) years. Indications for neuroimaging; unexplained encephalopathy 29 (39·7%), seizures 38 (52·1%), focal neurologic deficit 19 (26%), traumatic brain injury 6 (8·2%) and diplopia 2 (2·7%). The pMRI scan time was 51·3 min, provisional diagnosis of edema 27 (37·0%), hydrocephalus 12 (16·4%), Infarction 13 (17·8%), midline shift 13 (17·8%), intra-parenchymal hemorrhage 7 (9·6%), and intracranial mass 4 (5·5%) were made through pMRI. Compared to a standard neuroimaging, most pMRI findings agreed with an overall moderate agreement 73·91% (k 0·406, P 0·0003) between both modalities. pMRI is safe and feasible modality for diagnosing ABI in critically ill children and shows promising results in children admitted to PICU.