Murat Kocaoglu

Background: Conventional phased-array torso coils used for abdominal MRI are relatively heavy and inflexible, potentially affecting patient comfort and technologist workflow. Objective: To compare image quality, patient experience, and technologist experience using a recently United States Food and Drug Administration-cleared flexible, lightweight, blanket-like torso coil versus a conventional torso coil for pediatric abdominal MRI. Materials and methods: In this prospective institutional review board-approved study, 20 pediatric patients (7 years-old to 18 years-old) undergoing routine clinical outpatient abdominal MRI were imaged on the same 1.5-T system using both a conventional torso coil and a flexible blanket-like torso coil (Smart Fit TorsoCardiac; Philips Healthcare). After standard clinical imaging, selected sequences were repeated following coil exchange. Five pediatric radiologists independently evaluated paired image sets for subjective signal-to-noise ratio (SNR) and coil-related artifacts. Objective image quality was assessed using organ- and tissue-based SNR estimates and contrast-to-noise ratio (CNR) measurements. Patients and MRI technologists completed questionnaires regarding comfort, usability, and examination experience. Results: All 20 patients (median age, 15 years; 55% female) underwent imaging with both coils. Radiologists rated the novel coil as similar to the conventional coil for subjective SNR across all three sequences under study; coil-related artifacts were uncommon (2% of assessments for all sequences evaluated). Objective analysis showed no significant image-based SNR differences for most sequences, although the flexible coil demonstrated higher liver SNR on axial diffusion-weighted imaging (adjusted P =0.01). CNR did not differ between coils. Patients reported greater comfort and less anxiety with the flexible coil; 55% preferred it for future MRI examinations versus 20% for the conventional coil. Technologists also favored the flexible coil, with 70% expressing an overall preference. Conclusion: The flexible blanket-like torso coil provided image quality similar to a conventional coil and was generally preferred by patients and MRI technologists.

Background Balanced steady-state free-precession (bSSFP) cine imaging is the clinical standard for ventricular function assessment but requires multiple breath-holds, which can be challenging for pediatric and young adult patients. Deep learning (DL)–accelerated cine imaging offers the potential to reduce breath-hold burden, shorten scan time, and enable free-breathing acquisitions. Objective To clinically evaluate a commercially available DL-accelerated cine bSSFP sequence (SonicDL) across multiple acceleration levels and breath-hold/free-breathing configurations, and to assess diagnostic image quality, ventricular volumetric accuracy, and scan time reductions. Materials and methods This retrospective study included 25 patients with pectus excavatum and 15 with cardiomyopathy who underwent conventional cine imaging with breath-hold duration of nine cardiac-cycle interval (9-RR) and SonicDL acquisitions at 4-RR breath-hold, 1-RR breath-hold, and 1-RR free breathing. Diagnostic image quality was independently scored by three expert readers using a 5-point scale. Automated DL-based segmentation provided biventricular volumetric indices, with phase-contrast flow serving as the physiological reference for stroke volume. Statistical analysis included repeated-measures ANOVA, paired tests, ICCs, and Bland–Altman analysis. Results SonicDL significantly reduced scan time 57% (4-RR breath-hold), 79% (1-RR breath-hold), and 87% (1-RR free breathing) compared with 9-RR breath-hold imaging. Diagnostic image quality was highest for 4-RR breath-hold (median 4.50), significantly exceeding other protocols (P2 for most parameters) with limits of agreement typically within ±6 mL/m². Stroke volumes showed close agreement with phase-contrast flow (biases 1-5 mL/m²) across all protocols. In cardiomyopathy patients, diagnostic image quality was lower overall, but volumetric indices agreement remained within clinically acceptable ranges. Conclusion SonicDL cine bSSFP imaging substantially reduces breath-hold burden and scan time while maintaining diagnostic image quality and close agreement with conventional cine and physiologic flow measurements. The 4-RR breath-hold protocol provided the most favorable balance of acceleration and fidelity, while free-breathing acquisitions offered a practical alternative for patients with limited breath-hold capacity. Graphical abstract The alternative text for this image may have been generated using AI.

Background The main pulmonary artery (MPA) and branch pulmonary arteries (PAs) are commonly affected in congenital heart diseases, with residual postoperative abnormalities, a leading cause of reintervention. Objective To establish normative mean diameters, area and corresponding Z-scores for the MPA and branch PAs in teenagers, utilizing respiratory-navigated non-contrast ECG-gated 3D balanced steady-state free precession (3D bSSFP) magnetic resonance imaging (MRI) in systole. Materials and methods This retrospective study included patients with pectus excavatum deformity who underwent cardiac MRI between January and August 2023, excluding patients with aortopathies. Measurements of the PAs were obtained from non-contrast multiplanar reformatted 3D bSSFP datasets. Mean diameters and cross-sectional areas were calculated. Relationships between each vascular measurement and patient characteristics (age, height, and body surface area (BSA)) were assessed individually using weighted linear regression with inverse-density-based weights to account for data distribution. Additionally, Z-scores were calculated. Results The study included 112 patients (91 males [81%]; mean age, 14.3±1.7 years; mean BSA, 1.63±0.2 m²). All vessel measurements showed a positive trend with body size (height and BSA). Across categorical age groups, however, they did not exhibit a monotonic increase with age. Across all models, BSA was a statistically significant independent predictor of PA dimensions (p<0.01), with stronger associations observed for cross-sectional area than for diameter. Height contributed minimally and was not an independent predictor. Branch PA measurements—particularly right pulmonary artery, and to a lesser extent left pulmonary artery—exhibited slightly better model fit than the MPA. Conclusion We report normative reference values for mean diameters and cross-sectional areas of the MPA and branch PAs in children 10-18 years, obtained using respiratory-navigated ECG-gated non-contrast-enhanced 3D bSSFP MRI technique in systole. Graphical Abstract

Background Some children with inflammatory bowel disease (IBD) have hepatobiliary and/or pancreatic manifestations of the disease. The frequency of related imaging abnormalities at IBD diagnosis is unknown. Objective To identify and quantify hepatobiliary and pancreatic findings on baseline magnetic resonance enterography (MRE) examinations in children with newly diagnosed IBD. Materials and methods Children n=86) with Crohn disease; 22% (n=24) with ulcerative colitis; 1% (n=1) with IBD-unspecified. The mean age at diagnosis was 13.7 years (range, 5.3-17.9 years); 61% (n=43) were male. Subjective intrahepatic biliary dilation by reviewer consensus was present in 11% (n=12). Extrahepatic biliary dilation was present in 6% (n=7). Pancreatic duct dilation was present in 2% (n=2). Low pancreas:spleen T1 SIR (n=16). Pancreatic volume was 95th percentile in 13% (n=14). Conclusions Imaging findings potentially associated with autoimmune-related hepatobiliary or pancreatic disease are present in 2-14% on baseline MR enterography examinations in children with newly diagnosed inflammatory bowel disease. While infrequent, radiologists should be attentive to these findings of multisystem disease.

Purpose: Respiratory motion during data acquisition may compromise image quality and quantitative accuracy of MRI, particularly in patients with limited breath-holding capability. This study aimed to compare hepatic proton density fat fraction (PDFF), T2*, and T2 estimates of the liver obtained from breath-hold (BH) acquisitions with those from corresponding free-breathing respiratory-gated (RG) MRI acquisitions. Methods: In this IRB-approved study, healthy controls and patients with liver disease underwent quantitative liver MRI. Hepatic PDFF and T2* were estimated using a confounder-corrected chemical shift-encoded (mDIXON Quant) sequence, and T2 was estimated using a multi-echo Gradient and Spin Echo (mGRASE) sequence with fat suppression, each performed as both BH and RG acquisitions with identical acquisition parameters. Three observers independently drew regions of interest (ROIs) on PDFF, T2*, and T2 maps and agreement between mean values was compared using intraclass correlation coefficients (ICC) and Bland-Altman analysis. Results: Nineteen participants (15.4 ± 5.5 years; 9 males) were evaluated. Scan times were 7 s and 14 s (BH) and 21 ± 6 s and 28 ± 4 s (RG) for mDIXON Quant and mGRASE respectively. Estimated values from BH acquisitions were: PDFF – median 5% (range 1–43%), T2* – mean 27 ms (range 9–41 ms), and T2 – mean 48 ms (range 34–63 ms). RG and BH acquisitions yielded comparable values with biases of −0.33% [−1.42 to 0.76%] for PDFF, −1.58 ms [−9.50 to 6.33 ms] for T2*, and 0.16 ms [−2.43 to 2.12 ms] for T2, and strong correlations (ICC = 0.99 [0.99, 0.99], 0.85 [0.66, 0.94], and 0.99 [0.97, 0.99] for PDFF, T2*, and T2). Conclusion: RG acquisitions provide hepatic PDFF, T2*, and T2 estimates comparable to BH acquisitions without substantial time penalty and are a viable alternative for patients with limited breath-holding ability.

Background: Radiologic ulcers are increasingly recognized as an imaging finding of bowel wall active inflammation in Crohn disease (CD). Objective: To determine the frequency of ulcers at MR enterography (MRE) in children with newly diagnosed ileal CD, assess agreement between radiologists, and evaluate if their presence correlates with other imaging and clinical features of intestinal active inflammation. Materials and methods: This retrospective study included 108 consecutive pediatric patients (ages 6–18 years) with newly diagnosed ileal CD that underwent clinical MRE prior to treatment initiation between January 2021 and December 2022. MRE examinations were independently reviewed by three pediatric radiologists who indicated the presence vs. absence of ulcers, ulcer severity (categorical depth), and ulcer extent (categorical number of ulcers). Maximum bowel wall thickness and length of disease were measured and averaged across readers. Patient demographics and clinical inflammatory markers were documented from electronic health records. Inter-radiologist agreement was assessed using Fleiss’ kappa (k) statistics. Student’s t-test was used to compare continuous variables. Results: Mean patient age was 13.9 years (67 [62%] boys). Radiologic ulcers were recorded in 64/108 (59.3%) cases by reader 1, 70/108 (64.8%) cases by reader 2, and 49/108 (45.4%) cases by reader 3 (k = 0.36). Based on majority consensus, radiologic ulcers were present in 60/108 (55.6%) participants. Inter-radiologist agreement for ulcer severity was k = 0.23, while ulcer extent was k = 0.66. There were significant differences in C-reactive protein, erythrocyte sedimentation rate, fecal calprotectin, albumin, maximum bowel wall thickness, and length of disease between patients without and with radiologic ulcers (P < 0.05). The sensitivity and specificity of MRE for detecting endoscopic ulcers were 66.7% (95% CI, 52.1–79.2%) and 69.2% (95% CI, 48.2–85.7%), respectively. Conclusion: Radiologic ulcers are visible in children with newly diagnosed ileal CD, although inter-radiologist agreement is only fair. The presence of ulcers is associated with clinical laboratory inflammatory markers as well as other MRE findings of disease activity and is an additional imaging finding that can be used to evaluate intestinal inflammation.

Background High-fidelity cardiac magnetic resonance (MR) imaging plays a pivotal role in the surveillance of congenital heart disease (CHD) and aortopathy. Objective We aimed to evaluate the quality and accuracy of free breathing, ECG-gated noncontrast three-dimensional (3D) balanced steady-state free precession (bSSFP) in cases of CHDs and aortopathies using contrast-enhanced 3D bSSFP as a reference. We also used one of our routinely used non-ECG-gated 2D-single-shot (SSh) bSSFP sequence as an adjunct to noncontrast 3D bSSFP. Materials and methods Institutional review board approval was obtained to perform a systematic retrospective analysis of image quality and vascular measurements. Patients with CHD and aortopathy, who were undergoing clinically indicated contrast-enhanced 3D bSSFP, were prospectively identified to also undergo additional noncontrast 3D bSSFP and 2D SSh bSSFP imaging as part of a clinical quality improvement initiative aimed at reducing the use of contrast when feasible. Two readers, blinded to each other’s evaluations, graded image quality on a 5-point Likert scale and performed vascular measurements in separate sessions for both 3D bSSFP images. They also reported the visibility of various mediastinal great vessels on 2D SSh bSSFP images. Raw agreement, the weighted kappa statistic, and intra-class correlation coefficients (ICCs) were computed to assess the consistency and agreement between the two readers. Comparative analysis of noncontrast and contrast-enhanced 3D bSSFP imaging was performed in adult and pediatric patients using a two-sided paired t-test and Bland–Altman analysis. A P-value < 0.05 was considered significant for all inference testing. Results A total of 29 patients (17 males, median age 20.3 years, interquartile range (IQR) 12.5, age range 7–39 years), including 11 pediatric patients under the age of 18 years (6 males, median age 14.5 years, IQR 4.0, age range 7–17 years), underwent retrospective analysis. The overall image quality score for contrast-enhanced 3D bSSFP was significantly higher (P < 0.0001) than that of noncontrast 3D bSSFP for both all subjects (4.4 ± 0.2, range 4.0–4.9 vs 3.7 ± 0.4, range 3.1–4.7) and only pediatric subjects (4.3 ± 0.3, range 4.0–4.9 vs 3.6 ± 0.5, range 3.1–4.4). By combining noncontrast 3D bSSFP and 2D bSSFP, reader 1 and reader 2 rated 423 and 420 vessels diagnostic, respectively, in a total of 435 vessel segments. All landmarks showed similar mean vessel diameters without significant differences between noncontrast and contrast-enhanced 3D bSSFP MR angiography (r = 0.99, bias -0.31 mm, 95% limits of agreement -2.04 mm to 1.43 mm). Conclusions Although contrast-enhanced images had better overall image quality, an imaging protocol consisting of noncontrast 2D SSh bSSFP and 3D bSSFP whole-chest images provides diagnostically adequate image quality, and accurate vascular measurements, comparable to free-breathing contrast-enhanced 3D bSSFP in both children and adults with CHD and aortopathies. Graphical Abstract

Cardiac magnetic resonance (CMR) incorporates a field of view that has the potential to capture clinically relevant extracardiac findings (ECF); however, there has been minimal investigation of ECF prevalence in children’s hospitals, where the patient population varies in age and diagnosis. We retrospectively reviewed consecutive, clinically indicated, CMR studies performed at a tertiary care children’s hospital during a 1-year period from January 1 to December 31, 2019. ECFs were classified as significant or non-significant based on whether they were described in the final impression of the CMR report. A total of 851 distinct patients had a CMR study during the 1-year period. Mean age was 19.5 (range 0.2; 74.2) years. A total of 254 ECFs were present in 158 of the 851 studies (18.6%) with 9.8% of all studies having significant ECFs. A total of 40.2% of ECFs were previously unknown and 9.1% (23/254) of ECFs included further recommendations (2.1% of all studies). ECFs were most often found in the chest (48%) or abdomen/pelvis (46%). Three patients were incidentally found to have malignancy (renal cell, thyroid, and hepatocellular carcinoma). Comparing studies with significant ECFs to the group without, CMR indications for biventricular CHD (43% vs 31%, p = 0.036), single ventricle CHD (12% vs 3.9%, p = 0.002), and aortopathy/vasculopathy (16% vs 7.6%, p = 0.020) were more common. The odds of significant ECF increased with increasing age (OR 1.82, 95% CI 1.10–3.01) and increased most notably between ages 14 to 33 years old. Recognition of the high percentage of ECFs remains important for timely diagnosis of these incidental findings.