Keywords: Neonatal, Oxygenation

Motivation: Over 40% of neonates with moderate or severe hypoxic-ischemic-encephalopathy (HIE) still suffer from death, disability or neurodevelopmental delay after standard hypothermia treatment. Assessment of the brain’s oxygen metabolism may provide useful biomarkers to identify the risk of permanent neurologic injury and determine the necessity of adjuvant treatments.

Goal(s): To evaluate cerebral oxygen-extraction-fraction (OEF) and cerebral-metabolic-rate-of-oxygen (CMRO2) in neonates with HIE in comparison with healthy newborns.

Approach: We measured OEF and CMRO2 in 42 neonates with HIE and 52 healthy newborns.

Results: Neonates with HIE exhibited diminished OEF and CMRO2. Furthermore, a lower OEF predicted a longer stay in the neonatal ICU.

Impact: The brain’s physiological parameters such as oxygen-extraction-fraction can provide additional information (beyond standard clinical indices) for cerebral injury evaluation and treatment planning for hypoxic-ischemic-encephalopathy.

Keywords: Neonatal, CEST & MT

Motivation: Chemical exchange saturation transfer (CEST) has been employed for studying pH changes in acute phase of neonatal arterial ischemic stroke (NAIS), but not for long-term effects.

Goal(s): This study aimed to achieve longitudinal monitoring of NAIS evolution.

Approach: We constructed a 7-day-old NAIS rat model and explored the changes of brain metabolites by CEST-MRI. Contrast maps for contributing metabolites were calculated using Lorentzian Difference (LD) methods.

Results: All LD-quantified CEST contrast maps exhibit significant increase as age growth, in both sham group and the contralateral brain in NAIS group; Whereas the ischemic hemisphere displayed lower signals than the contralateral sides in NAIS group .

Impact: CEST signals displayed significant elevation over from 3h to 5w after surgery for both sham group and the contralateral brain tissue in NAIS group. This suggests the potential of CEST in sensitive and comprehensive assessment in NAIS diagnosis and management.  

Keywords: Neonatal, Pediatric

Motivation: Hypoxic ischemic encephalopathy (HIE) is the most important reason for morbidity and mortality in full-term infants.

Goal(s): This study aimed to investigate the clinical value of 3DASL perfusion imaging for the early diagnosis and prognosis of HIE in full-term neonates.

Approach: This study recruited 40 full-term HIE neonates and 40 healthy controls. Cerebral blood flow (CBF) values of bilateral frontal lobes, basal ganglia, thalamus were measured for comparison.

Results: The HIE groups showed significant decreased CBF values in the frontal lobes but significantly increased CBF values in basal ganglia and thalamus as compared to the control group.

Impact: We observed significant group differences between HIE neonates and healthy controls. 3DASL could reflect abnormal changes of cerebral perfusion in HIE infants and demonstrated the clinical value for early diagnosis and diagnosis of HIE.

Keywords: Neonatal, White Matter

Motivation: As the last myelinated structure, SWM is most affected by prematurity. Early exposure to the environment might injure the organization of SWM and lead to psychiatric disorders later in life.

Goal(s): To detect the impact of both preterm birth and “abnormal” brain injury on SWM microstructure.

Approach: TBSS method was used to track SWM in preterm infants of different degrees. The study aimed to detect changes in diffusion indices over time and identify distinct manifestations within the brain injury group.

Results: We were surprised to find that different degrees of preterm birth have different effects on the microstructure of superficial white matter.

Impact: The dose-dependent effect of preterm birth on SWM microstructure/developmental pattern. Further study the dynamic developmental association between SWM structure and neurodevelopmental outcomes in elderly children to gain a deeper understanding of the role of SWM in brain functional development.

Keywords: Neonatal, Neonatal

Motivation: To explore high-risk pregnancy effects on premature infant brain development. Conditions like preeclampsia, gestational diabetes, and thyroid dysfunction can profoundly impact fetal brain development.

Goal(s): To evaluate the correlation between synthetic MRI and Doppler ultrasound in assessing brain development in high-risk pregnancies.

Approach: 54 infants from high-risk pregnancies and 50 from low-risk pregnancies were studied, analyzing various brain regions and blood flow parameters.

Results: Findings indicate moderate correlations between synthetic MRI and Doppler ultrasound data, providing a comprehensive assessment of premature infant brain development in high-risk pregnancies, with specific MRI and blood flow correlations.

Impact: This study's findings expand our understanding of high-risk pregnancy effects on infant brain development. They offer clinicians a valuable tool for early intervention, potentially improving outcomes for premature infants born to high-risk mothers.

Keywords: Fetal, Brain

Motivation: MRI is crucial for the diagnosis and prognosis of hypoxic-ischemic encephalopathy (HIE). High-resolution imaging benefits the detection of subtle lesions. However, neonates may not tolerate lengthy scans .

Goal(s): To obtain ultrahigh resolution brain diffusion-weighted MR images(DWIs) within a feasible time frame to detect lesions invisible on images acquired using standard clinical protocols.

Approach: One b=0 volume and six DWI volumes at submillimeter isotropic resolution (0.86×0.86×0.86 mm³) were acquired using the Generalized SLIce Dithered Enhanced Resolution Simultaneous MultiSlice (gSlider-SMS) sequence, in addition to standard protocols.

Results: Ischemic lesions and cytotoxic edema invisible on standard clinical images were found on submillimeter resolution diffusion MRI data.

Impact: Submillimeter isotropic resolution diffusion MR images show lesions invisible on standard clinical images, which helps diagnose HIE earlier and more accurately for timely and appropriate treatment, as well as provides new biomarkers for accurate HIE staging.

Keywords: Neonatal, Neonatal

Motivation: There is currently no high contrast structural T₁-weighted protocol available for neonatal imaging at ultrahigh field (7T), as the longer T₁ relaxation times make existing protocols optimized for older subjects unsuitable.

Goal(s): To produce submillimeter T₁-weighted images for neonates at 7T in a clinically feasible scan time.

Approach: We optimised a T₁-weighted MP2RAGE protocol using the genetic algorithm for constrained optimisation while accounting for transmit field inhomogeneities.

Results: 3D whole-brain images with 0.65-0.8mm isotropic resolution were acquired in under 6-7 minutes from 3 infants. Quantitative T₁ maps were produced using an in-house fitting algorithm.

Impact: We describe the first neonatal optimised MP2RAGE protocol for acquiring high-contrast submillimeter-resolution images with full-brain coverage that are relatively insensitive to transmit field inhomogeneities.  

Keywords: Neonatal, Brain Connectivity, structure-function coupling

Motivation: Structure-function coupling (SFC) has been proposed to decode the relationship between anatomical structure and neural activity, but how SFC develops in the perinatal period remains largely unknown.

Goal(s): To establish typical SFC map at birth and portray its development during the perinatal period.

Approach: SFC of neonatal brains from 26 to 45 postmenstrual weeks were characterized using the dHCP data, and compared to that of adults. The developmental trajectories were depicted by GLM. 

Results: SFC at birth already demonstrated a sensorimotor-to-association pattern but were immature in somatomotor and frontoparietal networks compared to adults. SFC increased extensively and fastest in visual and limbic networks.

Impact: This study fills a gap in the SFC research during early development. Our findings characterized the brain connectome in term- and preterm-born neonates, revealing that visual regions developed earlier than somatomotor regions.

Keywords: Neonatal, Spectroscopy

Motivation: Alterations in brain metabolism before and after surgical repair of congenital heart disease is not well studied.

Goal(s): To investigate changes in key brain metabolites and primary neurotransmitters before and after cardiac surgery using ¹H-MRS.

Approach: Data were acquired in the cerebellum, right basal ganglia and right frontal lobe using MEGA-PRESS in 3T.

Results: Measurements of myo-inositol (mI) in the cerebellum were significantly higher in the preoperative CHD group compared to the healthy controls. γ-Aminobutyric acid (GABA) measurements were significantly higher in the right basal ganglia in the postoperative CHD group compared to the preoperative group.

Impact: Expanded investigation of brain biochemistry in neonates with congenital heart disease has revealed dynamic changes in key metabolites before and after cardiac repair, especially in key neurotransmitters GABA and mI which are known to play important roles in neurodevelopmental disabilities.

Keywords: Neonatal, Quantitative Susceptibility mapping

Motivation: Estimating iron and myelin contents in the newborn brain can be used to access neurodevelopment, but is challenging with conventional quantitative susceptibility mapping.

Goal(s): To separate positive and negative susceptibilities in the newborn brain and investigate differences between preterm and full-term newborns.

Approach: A total of 22 full-term and 10 preterm newborns were studied using quantitative susceptibility mapping with R2*-based source separation. Mean susceptibilities within 10 regions-of-interests were compared between full-term and preterm newborns.

Results: Preterm brains showed less positive and negative susceptibilities, compared to the full-term brains.

Impact: This study suggests that positive and negative magnetic susceptibilities in the newborn brain may be estimated individually using quantitative susceptibility mapping with source separation and may be used to identify early deviations from normal neurodevelopment in preterm-born infants.

Keywords: Neuro, MR Value

Motivation: Brain injury induced by neonatal hyperbilirubinemia is an important cause of abnormal development of infant nervous system. The traditional use of serum total bilirubin as a diagnostic marker is inconsistent and imprecise.

Goal(s): This study aims to investigate the relationship between different levels of bilirubin and quantitative parameters of SyMRI with hyperbilirubinemia.

Approach: A total of 107 NHB and 22 healthy infants were recruited in the study. Obtain T1, T2, and PD values by scanning SyMRI sequences.

Results: There were significant difference in T1 values of globus pallidus and cerebral peduncle at different levels of TSB, and there were negative correlation.

Impact: The assessment of neonatal bilirubin encephalopathy with increased signals from the pallidus has a high degree of subjectivity. SyMRI can reflect biological information through quantitative parameters, providing objective basis for the early diagnosis of NHB.

Keywords: MR Fingerprinting, MR Fingerprinting, Neonatal

Motivation: Motion artifact of MR Fingerprinting (MRF) cannot be recognized visually, but it affects quantitative values severely.

Goal(s): We aimed to assess the impact of motion in MRF and propose an objective motion-detection method.

Approach: We utilized Spatiotemporal Residuals (STR) from MRF-acquired signals and compared them with motion assessments in neonatal clinical practice.

Results: Our results revealed that motion significantly affects the accuracy of both T1 and T2 values. By applying an appropriate threshold to the standard deviation of STR, we achieved highly accurate motion detection equivalent to expert visual judgment, which leads to robust accuracy of quantitative values.

Impact: Our method to detect motion from MRF signals enables an objective assessment of the presence or absence of motion in MRF data. Consequently, this method facilitates the evaluation of the reliability of quantitative MRF images in clinical settings.

Keywords: Neonatal, Normal development, early preterm brain development

Motivation: BOLD signal variability (BOLD-SD) has emerged as a measure for assessing brain function, but little is known regarding its biological significance. 

Goal(s): Demonstrate that cortical BOLD-SD modifications are accompanied by structural intracortical maturational changes. Elucidate brain networks undergoing the most important maturational changes during early development.

Approach: Longitudinal brain MRI acquisition in preterm infants at 33 and 40 weeks’ gestational age. Assessment of cortical BOLD-SD and NODDI indices longitudinal modifications per brain network.

Results: A significant longitudinal cortical BOLD-SD increase is observed in primary sensory networks and Default-Mode-Network, accompanied by a decreased NDI (neurite-density-index) and/or increased ODI (orientation-dispersion-index), reflecting concomitant structural intracortical maturation.

Impact: During early brain development, the BOLD signal variability increase in resting-state networks was associated to underlying structural intracortical maturational changes and thus it can be considered as a marker of cortical maturation.

Keywords: Neuro, Brain Connectivity, Neurodevelopment, fMRI, Music

Motivation: Instrumental music and singing differ due to the vocal component of the sung melody and present distinct neural processing pathways, though its developmental origins remain unclear.

Goal(s): This study explores the early development of music vs singing brain processing.

Approach: Dynamic PPI-CAPs approach was applied to longitudinal fMRI data of preterm infants at 33- and 40-weeks gestational age.

Results: Singing elicited a stronger activation of salience and language-related networks, while music elicited limbic networks. Default-mode network and right temporal gyrus were elicited for both stimuli longitudinally. Visual network is also involved for both stimuli but only at term-equivalent age.

Impact: This study explores the longitudinal early development of neural processing networks in the context of instrumental and vocal music stimuli and shows that preterm infants already present a specialized processing for these different stimuli.

Keywords: Neuro, Brain

Motivation: Preterm male present high risk for neurodevelopmental disability. However, sex differences in preterm neurodevelopmental characterization is not yet known.

Goal(s): Investigate sex differences in neurodevelopmental evolution of preterm by exploring the postnatal age-related changes of brain white matter (WM) and neurobehavioral abilities.

Approach: The diffusion tensor imaging (DTI) parameter FA was applied to indirectly reflect the changes of brain white matter microstructure.

Results: The FA in preterm neonates is lower than term neonates which increased with postnatal age in both. Male presented significantly higher growth rate in certain brain regions compared with female especially for preterm male. 

Impact: Preterm male showed higher growth rate in certain brain regions which indicate a “catch-up” pattern toward the term neonates and this finding may suggest that certain intervention would be expected to work well in improving the preterm male outcome.

Keywords: Fetal, Fetus, Cortical development, gestational age prediction, shape signatures

Motivation: Capture more nuanced aspects of fetal brain cortex development.

Goal(s): Investigate the cortical surface of 65 fetal brain reconstructions from MRI examinations with global descriptors derived from scalar point-wise curvature-based metrics (H, K, SI, C, FI) and multidimensional point-wise shape signatures (HKS, WKS, SHOT).

Approach: The morphometric properties extracted by these descriptors were provided as input to SVR models to predict the gestational age. Two public atlases and one dataset were adopted to train and test the models, respectively.

Results: SHOT better encode the cerebral cortex development during pregnancy, achieving a prediction R² of 0.89 and MAE of 6.3 days.

Impact: SHOT provides researchers with sophisticated tool to capture more nuanced aspects of the fetal brain cortex development across gestational ages.

Keywords: Neuro, Neuro

Motivation: Direct contrast synthesis (AI-DCS) enables the derivation of synthetic images from a trained neural network.  Its utility in clinical practice has yet to be adequately explored.  

Goal(s): To evaluate the image quality and diagnostic confidence of these synthetic images in the brain in the pediatric population. 

Approach: The study radiologist compares the image quality and diagnostic confidence of AI-DCS images to standard of care (SOC) and SyMRI.  

Results: AI-DCS demonstrates better overall image quality and diagnostic confidence than SyMRI on T1, T2 and FLAIR in majority of patients.  AI-DCS demonstrates better overall image quality on FLAIR when compared to SOC.   

Impact: AI-DCS demonstrates improved image quality and diagnostic confidence compared to SyMRI and comparable image quality to the current standard of care.  

Keywords: Neuro, Diffusion/other diffusion imaging techniques

Motivation: Congenital heart disease (CHD) negatively impacts brain development and cognition.

Goal(s): We aim to elucidate the role of clinical and environmental factors on brain development and cognition.

Approach: A cumulative clinical risk (CCR) score derived from neonatal, cardiac, and neurological variables, brain connectivity metrics using diffusion-MRI, and cognitive outcomes were obtained in 53 CHD adolescents and 75 controls. 

Results: Higher CCR scores correlated with weaker brain network strength in a fronto-parietal-thalamic network, lower network segregation and poorer cognitive function, independent of family-environmental factors. These findings underscore the need for early risk assessment to predict brain development and aid vulnerable adolescents with CHD. 

Impact: Adolescents with congenital heart disease demonstrate altered brain networks, particularly those who face a cumulative exposure to multiple risk factors over time. Early assessment of risk load could help predict brain development and support the most vulnerable patients early on. 

Keywords: Neuro, Brain, metabolism, development

Motivation: N-acetyl-aspartyl-glutamate (NAAG) is a dipeptide and glutamate neuromodulator with possible significance as therapeutical target for injuries and diseases associated with glutamate neurotoxicity.

Goal(s): Determine age-dependent differences in its accumulation in white and grey matter in the human brain.

Approach: Existing MR spectra from 410 “closest-to-normal” pediatric patients and controls were evaluated.

Results: NAAG concentrations in the human brain were low and borderline detectable from birth to early childhood but then increased in late childhood in the parietal white matter whereas NAAG remained low in parietal grey matter.

Impact: This study demonstrates that NAAG accumulates at late childhood predominantly in WM. Furthermore, it suggests that in vivo MRS can be used to assess NAAG levels in disorders associated with excessive glutamatergic neurotransmission, such as childhood seizures.  

Keywords: Neuro, Brain, Cerebral palsy, Periventricular white matter injury, MRI, Diagnose, MultiReader MultiCase

Motivation: Early diagnosis of cerebral palsy  in infants with periventricular white matter injury is crucial for rehabilitation.

Goal(s): To develop and externally validate a MRI-based model to predict CP in infants with PWMI aged 6 to 24 months, and evaluate the diagnostic performance of the model using the MRMC analysis.

Approach: In this study, A MRI-based multivariable logistic regression model was develop at one center , and was validated at the three centers, and to evaluate the diagnostic performance of the model using the MRMC analysis. 

Results: The model showed both excellent predictive performance in the multicenter cohorts and high diagnostic performance  in MRMC analysis.

Impact: Our model is a reliable and reproducible tool for diagnosis of CP in infants with PWMI aged 6 to 24 months.

Keywords: Fetal, Fetus, gastrointestinal disorders

Motivation: In the prenatal diagnosis of gastrointestinal abnormality,fetal magnetic resonance imaging (MRI) is becoming increasingly relevant. 

Goal(s): T1-weighted sequences enable assessment of the presence of  meconium, allowing  diagnosis of  gastrointestinal abnormality, a method with a higher success rate and better image quality is necessary.

Approach: In this work, we compared the performance of three rapid 3D T₁-weighted imaging sequences for fetal gastrointestinal MRI at 1.5 T MRI scanner, including free-breathing radial and breath-hold, as well as the free-breathing multi-average 3D VIBE sequences. 

Results:  Our results demonstrated that free-breathing multi-average VIBE sequence not only demonstrates a higher success rate but also delivers superior image quality.

Impact: The T1WI images of  fetal gastrointestinal were barely satisfactory , which accompanied by motion and other artifacts.  It is necessary to find a scanning method that is tolerable to the mother and has good image quality.

Keywords: Neuro, Pediatric, Other Interventional

Motivation: Infantile Tremor syndrome (ITS) is a neurocutaneous syndrome observed in infants breastfed by vegetarian mothers who are deficient in vitamin B12. Its is accompanied by cerebral and white matter atrophy, delayed myelination, and delayed neurodevelopment.

Goal(s): To evaluate the efficacy of B12 treatment in infants with ITS on microstructural development and myelination using DTI.

Approach: In this longitudinal study, changes in DTI metrics are evaluated before and after vitamin B12 treatment using an atlas-based approach.

Results: Results show substantial increases in WM FA and decrease in WM RD, as evidence of the role of B12 in the myelination process.

Impact: Our findings will contribute to understanding the pathophysiological basis of ITS and highlight the efficacy of B12 treatment in rapidly reversing delayed brain development

Keywords: Neuro, MR-Guided Interventions

Motivation: Transcranial magnetic stimulation (TMS)-assisted rehabilitation therapy has demonstrated the potential to enhance prognoses in spastic cerebral palsy (SCP). However, there are still great differences in the efficacy among individuals. 

Goal(s): We employed personalized MRI-guided TMS to precisely target symptomatic neural circuits in children with SCP. 

Approach: We used DSI Studio software to track symptom-related fibre bundles within the cortex for targeting and analysed MRI structural and functional differences before and after treatment.

Results: Our findings revealed post-treatment improvements in the quantity, maximum length, and mean length of fiber bundles. Additionally, enhanced neural activity and improved consistency of neural signals were observed after treatment. 

Impact: Individualized MRI-guided TMS interventions have shown promise in ameliorating neurological symptoms in individuals with SCP.

Keywords: Neuro, Nervous system

Motivation: Non-invasive quantitative methods to assess the brain development of children with congenital heart disease (CHD) has been a hot topic . 

Goal(s): The main focus of this study is to investigate how MAP-MRI can be used to assess preoperative brain development in children with CHD.

Approach:  In this study, quantitative and correlational analyses of preoperative brain development in CHD children were performed using the multi-parameter indicators of the MAP-MRI diffusion model. 

Results: The results show that children with CHD exhibit cerebral microstructural abnormalities preoperatively, and MAP-MRI parameter indicators can be used for early prediction of preoperative neurodevelopment in CHD children.

Impact: MAP-MRI parameter indicators can serve as imaging reference values for preoperative brain development in children with CHD, aiding clinical professionals in focusing on the neurodevelopment of these patients while treating their CHD.

Keywords: Neuro, fMRI (resting state)

Motivation: Obesity and its associated comorbidities represent a health risk to population. This is even more relevant to children, as it can affect their cognitive development. 

Goal(s): Understanding the neurological pathophysiology of infant obsity is of paramount interest.

Approach: Find differences in functional connectivity between infant obese and normoweight groups. This using Resting State and ROI to ROI analyses

Results: Both groups presented the 15 RS-networks except for the Executive Control Network for the obese. The obese groups recruited three times more brain regions for the different RS-networks. ROI-to-ROI analysis presented larger number of connections for the Normoweight involving the Cerebellum and the Left-Inferior-Gyrus.

Impact: This is a first step in a larger project in which cognitive deficits of children associated with obesity are correlated to brain function through MRI and cytokine measurements. Here we establish ground differences between obese and normoweight cohorts. 

Keywords: Neonatal, Neonatal, Neonatal, Point-of-care MRI, Machine Learning/Artificial Intelligence, Segmentation

Motivation: To propose a new approach for managing hydrocephalus in neonates based on neonatal MRI and AI-based brain ventricle volume quantitation, brain parenchyma volume and ventricle-to-brain volumes ratio.

Goal(s): To evaluate the robustness of quantitative measurements of ventricle and brain volumes using AI-based algorithms, on scans acquired on a 1 Tesla permanent magnet neonatal MRI.

Approach: The performance of three AI-based segmentation algorithms was evaluated using linear correlations and Intersection over Union (IoU) score between ground truth and predictions.

Results: Results show high linear correlations between ground truth and algorithm predictions, validating  the use of these volumetric measurements to monitor hydrocephalus longitudinally.

Impact: An AI based method for segmenting neonatal MRI images may provide volumetric quantitation and enable fast and accurate decision making on surgical intervention in preterm infants with hydrocephalus.

Keywords: Neuro, Diffusion/other diffusion imaging techniques

Motivation: Given known associations between maternal distress during pregnancy and increased risk of offspring to develop psychopathology, it is critical to assess the influences of prenatal maternal depression & anxiety (pMDA) on infant brain organization.

Goal(s): To investigate the relationship between pMDA and GM organization and assess differences in this relationship between male and female infants.

Approach: In this study, we apply the NODDI GM- Based Spatial Statistics framework adapted for the infant brain to assess the relationship with pMDA and infant GM organization and investigate sex-related differences within this relationship.

Results: Our findings suggest a sex-dependent association between pMDA and infant GM microstructure.

Impact: Results may inform the development of interventions for maternal support during pregnancy.

Keywords: Neonatal, Pediatric

Motivation: The effect of preterm birth on cerebral oxygenation and its underlying mechanism have not been fully elucidated.

Goal(s): The goal of current study is to evalute cerebral oxygenation with non-contrast MRI techniques in a group of preterm-born neonates.

Approach: Cerebral oxygen extraction fraction (OEF) and metabolic rate of oxygen (CMRO₂) were measured with TRUST MRI together with cerebral blood flow (CBF) in 50 neonates.

Results: We showed that neonates with lower gestational age had higher OEF, lower CBF and lower CMRO₂, controlling for postmenstrual age. Higher OEF was associated with higher Apgar score. Hematocrit significantly mediated the increase of OEF in preterm neonates.

Impact: The results suggested a potential role of MRI-based oxygenation measurement in the assessment of transfusion and intervention for preterm neonates.

Keywords: Neuro, Pediatric, Cortex

Motivation: Congenital heart disease (CHD) is common and associated with impaired early brain development. 

Goal(s): To assess whether preoperative cortical Gyrification Index (GI) in infants with CHD deviates from the normal trajectory.

Approach: GI trajectories were normatively-modelled using reference control MRI data from 320 healthy infants, enabling calculation of GI Z-scores for the whole brain and frontal, occipital, parietal, temporal, cingulate and insular cortices for 130 infants with CHD, after accounting for sex, postmenstrual age at scan and days since birth at scan.

Results: Mean GI Z-scores were significantly lower for the whole brain and all cortical regions in infants with CHD (All P_FDR<0.018)

Impact: Global and regional brain gyrification is reduced in infants with critical or severe CHD in the neonatal period, prior to cardiac surgery, and these individualised measures of cortical folding are significantly associated with cerebral oxygen delivery in the neonatal period.

Keywords: Adolescents, Brain

Motivation: Magnetic resonance elastography (MRE) sensitively captures structural changes in the brain. However, application of this technique has been limited to cross-sectional studies in adolescents.

Goal(s): Our aim was to examine, for the first time, longitudinal changes in MRE-derived brain tissue mechanical properties during adolescence.

Approach: Shear stiffness and damping ratio were calculated for 14 adolescents during two study visits separated by a year.

Results: Stiffness significantly decreased over one year. The largest stiffness declines were in subcortical gray matter, in agreement with cross-sectional studies. Changes in both shear stiffness and damping ratio were correlated with progression of puberty.

Impact: This longitudinal study found wide-spread softening of brain tissue during adolescence, supporting cross-sectional findings. These changes were also correlated with the progression of puberty. This confirms the sensitivity of mechanical properties to capture structural changes of brain maturation.

Keywords: Genetics, Normal development, screening; neonatal; brain connectivity; connectome; transcriptome

Motivation: Transcriptome, representing the set of gene expression, exhibits spatiotemporal heterogeneity during brain development, underlying the dramatic changes in brain structural connectivity as measured by diffusion MRI throughout development.

Goal(s): Our goal was to elucidate the association between macroscopic structural connectome and microscopic transcriptome across development.

Approach: Here, we revealed this dynamic association between structural connectome and gene expression from a large cohort of 336 participants from fetal stage to adulthood.

Results: The changes of associated genes’ enrichment in cell types, biological processes, cellular components, and molecular functions across different ages shed light into the dynamic transcriptomic roles in connectome maturation.

Impact: By associating transcriptome map from over 6500 protein-encoding genes and dMRI-derived structural network, we revealed spatiotemporally heterogeneous transcriptome-connectome association from fetal stage to adulthood, providing insights into genetically patterned process of brain topological changes in health and disease.

Keywords: Normal Development, Normal development, Infants, Myelination, Preterm, ASD

Motivation: Myelination in the human brain extends from late pregnancy to the end of adolescence. Yet, its developmental pattern during this period is not fully understand.

Goal(s): We use the BCP dataset to investigate early brain myelination between 0-6 years old.

Approach: We utilized T1-/T2-weighted intensity, a surrogate marker for myelin.

Results: We identified five spatial patterns with distinct developmental trajectories and investigated the biological implications of myelination on developmental diseases, finding that the myelin content of corpus callosum had a significant fully mediated effect on ASD-related indicators. Furthermore, we found an alternation of myelination development affected by preterm birth in a separate cohort.

Impact: We investigated myelination patterns in infants and toddlers by T1w/T2w based on the BCP dataset and identified five distinct regional developmental trajectories. Using a mediation analysis, we found an intrinsic association between myelination and ASD-related restricted repetitive behaviors.

Keywords: Normal Development, Pediatric

Motivation: Very preterm children have a risk of impaired cognitive function mediated by several risk factors. The association between structural alteration and high-order cognitive function remains unclear.

Goal(s): Very preterm children at 6 years old showed significant differences in cortical thickness associated with cognitive abilities compared with term infants.

Approach: Cortical thickness was assessed in 41 very preterm and 24 full-term children at 6 years of age. The cortical thickness analysis of structural T1-weighted images was performed using Advanced Normalization Tools.

Results: Perceptual reasoning indices, high-order cognitive function, were found to be broadly correlated with cortical thickness in both very preterm and term children
 

Impact: This study explores the between brain structure changes and cognitive abilities in very preterm and full-term children, providing insights for neurodevelopmental diagnosis.

Keywords: Normal Development, Brain, perfusion; global developmental delay; arterial spin labelling; cerebral blood flow

Motivation: Early detection of global developmental delay (GDD) in young children is imperative for effective intervention.

Goal(s): The goal of this study is to determine whether CBF values, measured through 3D-pcASL, can aid in early GDD diagnosis and intervention.

Approach: Twenty-six children with GDD and 13 age- and sex-matched healthy controls underwent 3D-T1 and 3D-pcASL imaging. CBF values in various brain regions were analyzed and compared using statistical tests.

Results: The study found significantly lower CBF values in the right occipital lobe and left basal ganglia in GDD children. CBF values in these regions demonstrated potential as diagnostic markers for GDD.

Impact: This study's findings suggest that 3D-pcASL perfusion imaging can aid in early diagnosis of global developmental delay (GDD) in young children. Detecting GDD through non-invasive imaging may enhance early intervention, ultimately improving developmental outcomes.

Keywords: Spectroscopy, Data Analysis, Neonatal, Data Acquisition, Data Processing

Motivation: The Healthy Brain and Child Development (HBCD) study is a longitudinal, multi-vendor, multi-site study of early brain development, which will enroll ~7,500 infants. HBCD includes MRS within the imaging protocol.

Goal(s): The goal of this abstract is to present HBCD MRS pilot data, and identify any vendor and site differences in MRS data quality and measured metabolite concentrations.

Approach: HBCD pilot MRS data were successfully acquired on 28 scanners, and analyzed using Osprey 2.5.0, to examine vendor and site differences.

Results: ANOVA results show minimal vendor and site differences which is encouraging for such a large-scale multi-site, multi-vendor study.

Impact: HBCD is an NIH-funded multicenter study of brain development across the first decade of life. It is the largest ever study to incorporate MRS. In this abstract, we present in vivo data demonstrating MRS performance across vendor and site. 

Keywords: Adolescents, Drug Development

Motivation: Medication response in adolescent depression is unpredictable and relationships between dose, brain concentrations and clinical response are unknown. 

Goal(s): ¹⁹F-MRS is uniquely suited to study pediatric brain disposition, as it’s non-invasive, non-radiolabeled and less than minimal risk. 

Approach: Youth (n=52) aged 12-21 taking fluoxetine completed ¹⁹F-MRS at 3T.

Results: Brain fluoxetine concentrations exceeded plasma concentrations by 9 to 304-fold. Dose-normalized brain concentrations varied 13-fold, explained by plasma concentration and dose with small contributions from BMI, CYP2D6 and ABCB1. ¹⁹F-MRS is a valuable tool for studying pediatric brain disposition of fluorine-containing medications and enables inquiry into patient factors that impact brain exposure and response.

Impact: In vivo 19F-MRS measures brain concentrations of fluorine-containing medications and enables inquiry into individual-level factors contributing to brain disposition. This approach fills a critical gap in pediatric drug development, especially where other imaging modalities (e.g., PET) are not feasible.

Keywords: Cancer, Cancer, survivorship, late effects, apnea, sleep

Motivation:  Survivors of pediatric Hodgkin’s lymphoma (HL) have excessive daytime sleepiness and fatigue, with substantial consequences to quality of life. Thoracic radiation therapy (TRT), traditionally used to treat HL, is associated with cardiopulmonary morbidity and may result in sleep apnea.

Goal(s): Although sleep is known to impact neurometabolites in the general population, its effect on neurometabolite concentrations in HL survivors has not been established.

Approach: The present study used magnetic resonance spectroscopy (MRS) to explore the relationship between neurometabolites and sleep quality in pediatric HL survivors and community controls.

Results: We found associations between metabolites associated with excitotoxicity and neuroinflammation with sleep and age.

Impact: Our findings may identify therapeutic targets for interventions that mitigate the treatment-related late effects commonly experienced by HL survivors. Our results suggest that excitotoxicity and neuroinflammation could mediate the impact of sleep disturbances on age-associated late effects of cancer treatment.

Keywords: Tumors (Pre-Treatment), Cancer, metabolism, spectroscopy

Motivation: Metabolic mapping in Diffuse intrinsic pontine glioma (DIPG) may indicate prognosis and potential therapeutic targets.

Goal(s): We intended to identify metabolic ratios that indicated dysregulated metabolic pathways using 1H-MRS and determine whether these metabolites are associated with overall survival length.

Approach: We performed CSI in patients with DIPG prior to radiation therapy. Then we assessed the predictive value of a metabolite ratio for patient overall survival.

Results: Lactate and total choline levels were found to be significantly associated with patient overall survival, making them potential prognostic predictors of overall survival in DIPG.

Impact: This study shows that more aggressive DIPGs are metabolically distinct from less aggressive tumors and that the metabolic differences can predict the overall survival of patients.

Keywords: Cancer, Radiomics

Motivation: Medulloblastoma (MB) is classified into different molecular (WNT, SHH, Group 3, and Group 4) subgroups. Accurate identification of molecular subgroups provides clinical value to the diagnosis of MB.

Goal(s): We aim to combine APT MRI and radiomic analysis to establish signatures for distinguishing molecular subgroups of pediatric medulloblastoma.

Approach: Fifty newly diagnosed pediatric patients with medulloblastoma were enrolled in this study. Radiomic features were extracted from APT-related metrics to differentiate MB subgroups.

Results: APT MRI-based radiomic signatures exhibited favorable performance in identifying WNT, SHH, Group 3, and Group 4 subgroups with AUCs ≥ 0.91.

Impact: Our research findings demonstrate that amide proton transfer MRI-based radiomic analysis offers a noninvasive and cost-effective method to distinguish molecular subgroups and holds great potential in providing valuable clinical insights for the diagnosis of pediatric medulloblastoma patients.

Keywords: Structural Connectivity, Cancer

Motivation: Cognitive impairment following treatment of medulloblastoma has been associated with white matter structural changes and altered structural brain connectivity.

Goal(s): We hypothesized that decreased intensity therapy would reduce acute change in the working memory structural connectome.

Approach: Working memory structural connectomes were assessed relative to baseline after 15 Gy craniospinal irradiation (RT), after subsequent reduced-intensity chemotherapy, and during follow-up for 24 children treated for WNT-subtype (WNT) medulloblastoma.

Results: Changes after RT or chemotherapy showed small increases in connectivity strength in frontal striatal edges indicating little acute change. Follow-up revealed significant decreases in connectivity of the bilateral connections between caudate/thalamus.

Impact: Increased connectivity of frontal striatal edges after therapy and decreased connectivity of caudate/thalamus edges in follow-up for patients receiving reduced intensity therapy for WNT medulloblastoma may indicate a low incidence of acute changes.

Keywords: Cancer, Brain, pediatric brain tumor

Motivation: Pediatric brain tumors is the most common cancer among the pediatric population, and DWI-imaging offers a non-invasive method to assess tumor grade to guide appropriate treatments. 

Goal(s): The study investigates the feasibility of DISMANTLE, an integrated DWI approach for simultaneous assessment of tissue cellularity, vascularity, and heterogeneity, in differentiating high-grade and low-grade pediatric brain tumors.

Approach: Seventy pediatric patients with brain tumors, categorized into high-grade and low-grade, were scanned with DWI sequence. Images were analyzed using DISMANTLE and 3 comparison models.

Results: Removing the perfusion-related signal in DISMANTLE improved the accuracy and sensitivity of diffusion-related parameters in assessing pediatric brain tumor grades.

Impact: The study emphasizes the importance of appropriate signal characterization and fitting strategies for high b-value DWI in robust assessment of brain tumors. Future DWI modeling should consider segmentally fitting the diffusion and perfusion-related signals.

Keywords: Visualization, Cardiovascular, UTE, Access, Vasculature, Quality, CHD, Contrast, Chest, Abdomen, Diagnostic

Motivation: The motivation for this study is to propose an alternative and more efficient imaging protocol for vascular access assessment for complex congenital heart disease (CHD) cases

Goal(s): To determine if UTE imaging can provide a supplemental tool to conventional MR imaging for evaluating vascular access in the context of CHD.

Approach: Selection of 15 patients undergoing pre-operative assessment for complex CHD, including ferumoxytol administration, implement a 3D UTE sequence and a quality scoring scale.

Results: The study concludes that UTE imaging is a time-efficient method to visualize vascular anomalies, patency, occlusion, and access, and it can complement MRI planning for cardiovascular procedures.

Impact: Our study demonstrates that UTE imaging with ferumoxytol can provide high-quality vascular access imaging for patients with complex CHD. This offers an improved diagnostic tool for assessing vascular access as an important addition to the tools available for CHD evaluation.

Keywords: Cancer, Tumor, Hepatoblastoma; Metastasis; UTE

Motivation: UTE MR has demonstrated its potential for evaluating pulmonary lesions, which could be employed for assessing pulmonary metastasis from hepatoblastoma.

Goal(s): To investigate the diagnostic performance of UTE MR for detecting pulmonary nodules and thus diagnosing pulmonary metastasis in pediatric hepatoblastoma patients.

Approach: Lung UTE was assessed for its capability to detect nodules and for its diagnostic performance for pulmonary metastasis.

Results: UTE has a moderate diagnostic sensitivity for metastasis, while its specificity is high. When it comes to single pulmonary nodules, UTE has a moderate detection rate with a relatively high false positive detection rate.

Impact: UTE has a moderate diagnostic sensitivity for pulmonary metastasis, while its specificity is high. To make MR imaging a reliable one-stop assessment tool, higher resolution UTE imaging technology will be needed in the future.

Keywords: Body, Pediatric, LAVA-Flex, 3D FLEX

Motivation: Fat suppressed T1 images, such as LAVA-FLEX, are routinely used in pediatric abdominal imaging, but can suffer for SNR and IQ issues. 

Goal(s): Our goal was to validate application of 3D deep learning to 3D LAVA-FLEX via image quality assessment and noise characterization.

Approach: DL and conventionally reconstructed images were assessed by two radiologists and noise characteristics were evaluated by calculation of total variation and number of detected edges. 

Results: The radiologists preferred DL in a majority of cases (>80%), with noticeably lower noise and improved sharpness in DL images. 

Impact: The application of DL to routine pediatric 3D LAVA-FLEX imaging provides enhanced diagnostic quality, and has the potential to improve pediatric patient care.

Keywords: Cardiovascular, Cardiovascular, Noonan syndrome; non-syndromic hypertrophic cardiomyopathy; cardaic MRI; young children

Motivation: The high prevalence of cardiac involvement necessitates comprehensive cardiac exploration at diagnosis and during follow-up in NS, especially when NS was found to be a risk factor in children with HCM

Goal(s): Our study aimed to identify and assess the cardiac MRI features of NS in comparison with non-syndromic HCM in a cohort of young children

Approach: 10 young children genetically confirmed with NS and 10 children genetically confirmed with HCM were evaluated by cardiac MRI

Results: ROC curves documented the diagnostic performance of MRI features(LGE quantification, T1 mapping and strain analysis) in differentiating NS patients from HCM patients

Impact: We performed comprehensive evaluation of pediatric NS by comparison with non-syndromic HCM, and defined a vital role of cardiac MRI in NS. Comprehensive cardiac MRI findings will provide more insights into the rare hereditary cardiomyopathy for researchers and clinicians

Keywords: Fetal, Fetus

Motivation: Maternal supine sleeping position in the third trimester has been linked to decreased uterine blood flow and increases in stillbirth.

Goal(s): To investigate the impact of maternal position on fetal and placental T2* values by taking advantage of the increased dynamic T2* range at low field strengths

Approach: We acquired dynamic whole uterus multi-echo gradient echo sequences at 0.55T with the subject in both left lateral and supine positions and compare the T2* placental and fetal body organ values organs in 91 subjects.

Results: Significant differences in mean T2* values were observed between both positions in the placenta and 7 fetal body organs.

Impact: Maternal position significantly impacts mean placental and fetal body T2* values. In addition, future quantitative fetal T2* studies should consider maternal position in their study design.

Keywords: Cancer, Spectroscopy, DIPG, Pediatrics, NMR

Motivation: There is a need for developing next generation of clinical trials by targeting selective pathways in diffuse intrinsic pontine glioma (DIPG).

Goal(s): We explore the impact of Vehicle (DMSO), Paxalisib, BAY-876, and their combination in patient-derived SJ-DIPGX7 cell line to evaluate their potential as a therapeutic strategy for patients with DIPG.

Approach: 2H-NMR spectra were longitudinally obtained in a cell suspension. We calculated the lactate flux turnover, which was validated using 100-run Monte-Carlo simulation. This outcome was further confirmed by conducting a glycolysis stress test. 

Results: The combined therapy (Paxalisib + BAY-876) holds potential for enhancing its therapeutic effectiveness against DIPGs.

Impact: This study paves the way for future in-vitro and in-vivo studies to be conducted for monitoring efficacy of targeted therapeutic combination for DIPG.

Keywords: Neuro, Diffusion Tensor Imaging

Motivation: Diffusion MRI (dMRI) is promising for predicting disabilities due to neonatal hypoxic-ischemic encephalopathy (HIE), yet current automated image quantification methods are slow and unvalidated for HIE lesions.

Goal(s): Develop a rapid deep-learning model, OpenMAP-Di, to quantify dMRI with and without HIE injury to predict the short-term outcome (STO) score.

Approach: We utilized nnU-Net to develop OpenMAP-Di, enabling dMRI parcellation and quantification, and applied an elastic regression model to predict the STO score.

Results: OpenMAP-Di accurately parcellated and quantified infant brains across varying scanners, acquisition parameters, and HIE severity levels in three minutes, and can also predict STO.

Impact: The increased processing speed and robustness to technological and pathological variations offered by OpenMAP-Di promises timely and reliable future neurodevelopmental outcome assessments for individuals surviving HIE, while also offering researchers opportunities for extensive medical image analysis.

Keywords: Neuro, Velocity & Flow, Brain Arteriovenous Malformation

Motivation: Approximately 10-20% of pediatric patients with brain arteriovenous malformation (bAVM) present with reoccurring formation or growth even after initial successful treatment.

Goal(s): Evaluate the feasibility and efficacy of 4D Flow MRI to quantitatively assess the hemodynamic changes in pediatric bAVMs following treatment and establish its use for early detection of high-risk changes.

Approach: Prospective 4D Flow MRI study of pediatric bAVM patient cohort pre and post treatment

Results: Decreased flow rate and maximum velocity in main bAVM feeding arteries post treatment, resulting in reduced flow laterality mismatch between hemispheres.

Impact: 4D Flow MRI provides a quantitative tool to assess pediatric bAVM flow characteristics and the hemodynamic impact of intervention, which may help to identify patients at risk of bAVM reoccurrence.

Keywords: Neuro, White Matter, autism spectrum disorder

Motivation: Autism spectrum disorder (ASD) lacks sensitive and effective imaging biomarkers.

Goal(s): Using diffusion tensor imaging to detect white matter tracts damage and changes in local directional fields in children with ASD and combining machine learning to construct a diagnostic model for preschool-aged children with ASD.

Approach: Introducing the novel mathematical framework of director field analysis, we investigate the local geometric structure of white matter tracts using tract-based spatial statistics and automated fiber quantification techniques.

Results: Children with ASD have reduced fractional anisotropy and increased twist and distortion values. The machine learning model showed an area under the curve of 0.85 for diagnosing ASD.

Impact: The director field analysis parameters fill the gap in previous studies and provide a new perspective for exploring the neuropathological mechanisms of ASD. By combining machine learning, the diagnostic efficiency of ASD is improved.

Keywords: Neuro, Brain, Brain, quantitative imaging, relaxometry, pediatric, synthetic MR

Motivation: Rapid multi-contrast MRI acquisitions are crucial to minimize motion artifacts in awake pediatric subjects.

Goal(s): To evaluate a newly developed EPI-based multi-contrast MRI sequence for generating multi-parametric quantitative brain maps in awake pediatric participants.

Approach: T₁, T_2, and T₂^* measurements were obtained using the rapid imaging sequence in 17 children (age 3-10 years). The parametric values were compared to those acquired using conventional mapping sequences, and repeatability and reproducibility were assessed.

Results: The brain relaxation parametric values obtained with the rapid sequence were comparable to those obtained through conventional acquisitions. Furthermore, these values exhibited good repeatability and reproducibility.

Impact: Rapid (1 minute and 15 seconds) measurements of T₁, T₂, and T₂^* in the brains of awake children (aged 3-10 years) were comparable to those obtained using conventional quantitative mapping methods.

Keywords: Neuro, Motion Correction, Quiet

Motivation: Improve imaging for pediatric subjects by reducing loud acoustic noise and accommodating subject motion. 

Goal(s): Develop a ZTE-based silent and motion-corrected neuroimaging protocol in pediatric subjects.

Approach: Nine pediatric volunteers were imaged with a protocol consisting of silent ZTE based T1w and T2w acquisitions and conventional Cartesian 3D gradient echo T1 MPRAGE and T2 FSE-CUBE.  Images were reviewed and scored by a board-certified radiologist to assess overall image quality.

Results: Radiologist review indicates relatively comparable image quality for the ZTE acquisitions versus the conventional acquisitions. Motion induced blurring of some brain structures during motion was reduced using ZTE with motion correction.

Impact: This approach shows promise for studies in sensitive populations such as pediatrics with ear disorders and autism spectrum disorder.

Keywords: Neuro, Brain, Spectroscopy, Autism, Neurological, Analysis

Motivation: ¹H-Magnetic Resonance Spectroscopy (MRS) studies have revealed alterations in neuro-metabolite concentrations in autism, but results have been inconsistent.

Goal(s): Perform a comprehensive meta-analysis of previous MRS studies in autism.

Approach: Data was included from 59 relevant studies. After assessment of data quality, data was grouped by metabolite, brain region and other demographic and methodological factors.

Results: We find significantly lower concentrations of GABA and NAA in autism. These alterations were most pronounced in children and in limbic brain regions involved in processes relevant to autism phenotypes. We also investigate factors that contribute to effect size variation between studies, including MRS quantification method.

Impact: Our meta-analysis comprehensively summarises previous MRS studies to provide evidence of regional disruptions to brain metabolite concentrations in autism. We also examine how MRS study outcome varies due to methodological and demographic factors.  

Keywords: Neonatal, Brain

Motivation: Clinical diagnosis of neonatal acute bilirubin encephalopathy (ABE) based on the conventional MRI sequence has been limited by its difficulty in differentiating confounding image contrast changes associated with normal myelination. 

Goal(s): This study aims to assess the value of quantitative susceptibility mapping (QSM) in detecting ABE and understanding its pathogenesis.

Approach: All MRI scans were carried out on 3.0T MR scanner (Omega, United Imaging Health Care, Shanghai, China) with multi-parametric MR imaging with flexible design (MULTIPLEX) transverse axis sequence.

Results: ABE caused significant magnetic susceptibility value changes in several brain regions which showed correlation with peak total serum bilirubin value.

Impact: Our study demonstrated that the brain regions with altered magnetic susceptibility values might be related with ABE pathology, which might be valuable for further studies. And QSM might have the potential efficacy in the auxiliary diagnosis of ABE.

Keywords: Neuro, Diffusion/other diffusion imaging techniques, OGSE; IMPULSED; Glioblastoma; cellularity；cell diameter

Motivation: Gliomas are the most common type of central nervous system tumors in children, and the histological classification plays a crucial role in determining the prognosis and the treatment. A non-invasive approach is needed for pre-surgery characterization of the histopathology of the tumor.

Goal(s): The aim of this study was to explore the feasibility of applying time-dependent diffusion magnetic resonance imaging (t_d-dMRI) parameters in discriminating between high-grade gliomas (HGG) and low-grade gliomas (LGG).

Approach: Nine pediatric glioma patients were involved and underwent t_d-dMRI scan.

Results: The t_d-dMRI parameters may serve as potential markers for the differentiation between high-grade gliomas (HGG) and low-grade gliomas (LGG).

Impact: Time-dependent diffusion MRI parameters can distinguish pediatric high-grade and low-grade gliomas noninvasively, aiding personalized treatment and enhancing prognosis, among other potential applications.

Keywords: Neuro, Pulse Sequence Design, T1 Mapping

Motivation: T1 mapping is essential for demyelination disease diagnosis and brain development assessment, but conventional sequences suffer from considerable acoustic noise or long scanning time. 

Goal(s): This study aims to develop a silent, accurate and fast 3D T1 mapping method.

Approach: It uses inversion recovery-prepared rotating radial trajectories to avoid significant gradient switching, forming a series of images collected at different TIs. 

Results: Its accuracy is compared with IRSE method, acquiring 0.9994 R², and its feasibility is tested on the human brain with gray and white matter T1 values close to literatures. The SPL is measured only 1.5 dBA higher than the background noise.

Impact: The high acoustic noise of sequences like MPRAGE has disadvantages for pediatric imaging due to its risks of neonatal hearing loss and decreased scanning comfort. Our study might provide a solution with nearly silent sound and highly accurate measurements.

Keywords: Neuro, Quantitative Imaging

Motivation: Children with congenital heart disease (CHD) may exhibit brain development abnormalities, making it crucial to understand the risk and improve neurological function in these patients. 

Goal(s): In this study, we aimed to quantitative assessment of preoperative brain development in CHD children using Synthetic Magnetic Resonance Imaging (SyMRI).

Approach: Through the quantitative evaluation and correlation analysis of T1, T2 and and PD values of SyMRI in the preoperative brain development of children with CHD.

Results: The results indicate that the presence of neurological development abnormalities existed in children with CHD before surgery. SyMRI can provid a basis for early clinical evaluation and timely intervention.

Impact: SyMRI quantitative assessment can serve as a reference indicator for brain development abnormalities in CHD children, aiding in guiding early clinical evaluation and timely intervention.

Keywords: Neuro, Motion Correction, Segmentation

Motivation: Head motion is a common cause of image degradation in pediatric neuroimaging. Multiple strategies are available for correcting intrascan motion, including DISORDER - a retrospective motion correction approach.

Goal(s): We aimed to validate the use of DISORDER for brain morphometric analyses in a pediatric population.

Approach: We compared a wide range of morphometry measures obtained from high quality linear phase-encoding MPRAGE and DISORDER MPRAGE acquisitions in 21 children aged 7-8 years.

Results: DISORDER reduced data loss due to motion and brain morphometric analyses obtained using both MPRAGE acquisitions were highly consistent for most brain regions.

Impact: DISORDER, a retrospective motion correction technique, reduces data loss due to head motion in pediatric populations and produces quantitative brain morphometric measures that are largely consistent with measures derived from a standard acquisition.

Keywords: Neonatal, Brain Connectivity, congenital heart defects

Motivation: Structural connectivity in the thalamus, essential for cortical-subcortical communication, is known to be disrupted in congenital heart defect (CHD) patients. Yet, assessing thalamic nuclei via local diffusion characteristics in vivo remains challenging. 

Goal(s): We aimed to validate a diffusion-based clustering method to map the developing thalamus and explore topological differences between CHD infants and healthy controls

Approach: By refining a segmentation method and employing k-means and GMM clustering, we characterized thalamic nuclei

Results: Notable volume reductions in six thalamic clusters were identified in CHD infants, with significant mediodorsal nucleus group alterations, pertinent to prefrontal connectivity

Impact: Our validated segmentation technique enables robust delineation of thalamic nuclei in vivo, unveiling developmental alterations in CHD infants. This advancement paves the way for targeted clinical interventions and improves neurodevelopmental outcomes prediction

Keywords: Neuro, Adolescents, Congenital Heart Disease Neurodevelopment Brain Dysmaturation Evaluation Method

Motivation: Develop and validate point-of-care MRI-based evaluation method for scoring brain dysplasia/abnormality (BDS) in congenital heart disease (CHD) that incorporates morphological alterations and subcortical structures.

Goal(s): Further develop our BDS system, previously validated in infants with CHD, in the older pediatric and young adult CHD population.

Approach: Evaluate brain dysplasia from T1 and T2 structural MRI of CHD and control participants and compare differences. Correlate BDS with executive function outcomes and genetic ciliary motion (CM) abnormalities.

Results: CHD group had higher total and subcortical dysplasia, especially single ventricle CHD group. Higher BDS (greater dysplasia) correlated with poorer executive function outcomes and greater CM abnormality.

Impact: Our BDS method is sensitive to dysmaturational features in CHD and correlated with executive function outcomes and CM - genetic-basis of CHD pathogenesis. Since it employs common point-of-care MRI techniques, it could be adapted for wider application in CHD brain evaluation.

Keywords: Neuro, Pediatric, Maternal anaemia, haemoglobin, high-field MRI, neurodevelopment, neuroimaging, child brain structure

Motivation: It is unknown whether recent findings linking antenatal maternal anaemia with altered brain structure in toddlers persist to later childhood.

Goal(s): This study aimed to determine whether associations of antenatal maternal anaemia with smaller corpus callosum, putamen, and caudate nucleus volumes described in 2–3-year-olds remain at age 6-7 years in the same cohort.

Approach: Linear modeling was used to investigate associations between antenatal maternal anaemia status, maternal haemoglobin concentrations, and child brain volumes.

Results: Antenatal maternal anaemia was associated with smaller volumes of the corpus callosum and caudate nucleus in school-age children, with comparable adjusted volume differences and coefficients to findings in toddlers.

Impact: Evidence that associations of maternal anaemia with brain volumes are consistent and persist from age 2-3 years through to age 6-7 years supports the importance of optimizing antenatal maternal health and reinforces these brain regions as a future research focus.

Keywords: Elastography, Data Analysis, Brain, Liver, Inflammation, Neuroinflammation

Motivation: Obesity is associated with numerous debilitating diseases. Obesity-related conditions once only seen in adults are now being seen in children. Obesity affects numerous organs and may affect a child's ability to learn.

Goal(s): Identify changes in liver and brain stiffness measurements in the pediatric population that may indicate signs of early-stage disease.

Approach: MR elastography images of the liver and brain were obtained and compared to dual energy X-ray (DXA) metabolic measurements.

Results: Significant correlations between obesity and stiffness changes in the thalamus and amygdala were identified. 

Impact: Preliminary results show that changes in liver and brain microstructure of the pediatric population can be seen in correlation to increased adiposity. MR elastography is a valuable tool in diagnosing those early changes.    

Keywords: Adolescents, MR Value, ADHD, Functional connectivity

Motivation: Although youth with attention-deficit/hyperactivity disorder (ADHD) with a family history of bipolar I disorder (BD) are at increased risk for developing BD, associated neurofunctional mechanisms remain understood.

Goal(s): To investigate the differences in functional connectivity (FC) between ventrolateral prefrontal cortex (VLPFC) and amygdala (AMY) among ADHD youth with (‘high-risk’, HR) and without (‘low-risk’, LR) a BD family history and healthy controls (HC).

Approach: gPPI analysis was conducted to assess the VLPFC-AMY FC in response to unpleasant emotional stimuli. 

Results: Both LR and HR exhibited lower right VLPFC-left AMY FC compared to HC, and HR had even lower FC compared with LR. 

Impact: ADHD in conjunction with BD family history showed blunted emotion-generated right VLPFC-left AMY FC compared with ADHD youth without a BD family history and healthy youth, and may therefore represent a central biomarker that is relevant to BD risk progression.

Keywords: Neuro, Metabolism

Motivation: It is unclear whether the lack of growth hormone (GH) is accompanied by altered GABA in human brain and relationship between the alterations and neuronal activity.

Goal(s): Thalamus is one of brain region that has highest concentration of GH receptors. The purpose of this study was to explore changes in GABA concentrations in thalamus and its association with neuronal activity in children with GHD.

Approach: We used MEGA-PRESS sequence to quantify the concentration of GABA+ in thalamus and rs-fMRI to assess neuronal activity.

Results: We found that the levels of thalamus GABA+ decreased significantly, and it was related to abnormal neuronal activity.

Impact: This study provides a new insight into the neural mechanisms of cognitive dysfunction in children with GHD, and holds a promising biomarker for us to find a new treatment approach to GHD.

Keywords: Neonatal, Brain, Brain iron metabolism

Motivation: The motivation of this study was to investigate the changes in brain iron metabolism in neonates with hyperbilirubinemia (NHB).

Goal(s): The goal was to assess the diagnostic value of QSM in NHB and explore its brain iron metabolism.

Approach: Clinical trial

Results: Brain iron content can dynamically change with serum bilirubin level in NHB, and brain iron content was significantly higher than that of healthy neonates in the putamen.

Impact: The QSM value of the putamen can accurately diagnose NHB, and provide early warning of brain injury.

Keywords: Neuro, Brain, autism spectrum disorder, attention-deficit/hyperactivity disorder, cortical thickness, meta-analysis, surface-based morphometry

Motivation: Autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are neurodevelopmental disorders with overlapping behavioral features and genetic etiology. Exploring brain cortical thickness (CTh) could help understand the neurobiological basis which builds the bridge between clinical manifestations and genetic liability of the two disorders.

Goal(s): To demonstrate the common and distinct of CTh changes in ASD and ADHD.

Approach: Previous brain structural MRI studies analyzing CTh of ASD and ADHD were included and compared by vertex-based meta-analysis.

Results: The ASD showed disorder-specific increased thickness in parietal lobule, and ADHD-specific decreased CTh was in motor area. Both disorders shared thinner thickness in temporo-parietal junction.

Impact: The shared and different patterns of CTh alterations in ASD and ADHD provide objective evidence for transdiagnosis. The subtle differences in areas with distinct functions could partly explain the divergent behavioral features in the two disorders and elucidate disorder-specific etiologies.

Keywords: Neuro, Neurofluids

Motivation: Enlarged CSF volumes have been reported in children with congenital heart disease (CHD), and have been linked to neurodevelopmental outcome, but the origin of these enlarged CSF volumes is not yet known.

Goal(s): To examine the link between CSF flow, arteriovenous flow and CSF volumes in order to improve our understanding of the observed changes in CSF volume.

Approach: Phase contrast MRI of the cerebral aqueduct, carotid arteries and jugular veins was combined with 3D anatomical MRI for segmentation of the CSF spaces.

Results: CHD children show hyperdynamic CSF flow, which is linked to enlarged 3^rd ventricle volumes and venous flow.

Impact: An improved understanding of the link between heart defects and brain development and hydrodynamics may help to foster improved development and outcome for children with CHD in future.

Keywords: Neuro, Brain

Motivation: Currently, many studies have applied the DKI technique in adults, while fewer studies have applied this technique in children, especially in children with ADHD

Goal(s): Explore the feasibility of applying DKI technology to the brain of children with ADHD

Approach: 72 children with ADHD and 79 age- and sex-matched healthy controls were included in the study. All children were examined by means of 3D-T1weighted image , DKI and conventional sequence scanning

Results: DKI showed abnormal gray matter and white matter development in some brain regions of children with ADHD.

Impact: DKI imaging showed abnormal gray matter and white matter in frontal lobe, temporal lobe, Caudate nucleus and other brain regions of ADHD children. The brain volume of ADHD is lower than that of healthy children.

Keywords: Neuro, Preclinical

Motivation: According to the clinical findings, the survivors of necrotizing enterocolitis (NEC) may suffer from long-term neurodevelopmental impairment. However, how the local intestine inflammation impacts brain function needs further investigation.

Goal(s): To probe the long-term alteration in the brain network induced by NEC in early life.

Approach: After employing a neonatal rat model of NEC with lipopolysaccharide at postnatal 7 days, we measured the functional connectivity in the brain in its adolescent age (about P40).

Results: Neurodevelopmental impairment induced by mild early-life NEC was reflected by rsfMRI in adolescent rats.

Impact: We provide evidence showing that preterm NEC may induce the subsequent alteration in the functional brain network. Our results indicate the association between the early-life local intestine inflammation and long-term neurodevelopmental impairment, suggesting the interaction of the gut-brain axis.

Keywords: Rare Disease, Diffusion Tensor Imaging

Motivation: Type II GM1 gangliosidosis is a rare disease that lacks reliable quantitative biomarkers to assess neuronal health.

Goal(s): We sought to quantify diffusion tensor imaging (DTI) parameters of different brain regions known to be affected in GM1 to track neuronal changes especially with the advent of gene therapy in treating GM1.

Approach: We quantified fractional anisotropy and radial diffusivity changes at different timepoints using DTI-MRI to evaluate myelination changes in GM1 patients treated with gene therapy and compared them to untreated patients and healthy controls. 

Results: DTI can be used to demonstrate efficacy of gene therapy in monitoring disease progression/regression in GM1 patients.

Impact: This study addressed the need for reliable biomarkers in assessing neuronal health in type II GM1 gangliosidosis. Using DTI parameters, we demonstrated the efficacy of gene therapy in reliably monitoring myelination changes in GM1 patients.

Keywords: Cancer, Metabolism, Molecular Imaging, Preclinical, Ewing sarcoma, pediatric cancer

Motivation: Chemo resistance in Ewing sarcoma (EWS) poses a significant hurdle, especially considering the unclear role of the SLFN11 gene. Uninvestigated metabolic dependencies call for an in-depth exploration to improve treatment effectiveness. 

Goal(s): This research endeavors to connect metabolic changes in EWS with SLFN11 expression, aiming to identify diagnostic markers that could provide mechanistic insights into therapy design.

Approach: Our study integrates metabolomics, transcriptomics, in-vitro nuclear magnetic resonance (NMR), and preclinical magnetic resonance spectroscopy (1H MRS) to examine how SLFN11 influences chemoresistance in EWS, ultimately paving  way for metabolism-driven treatments.

Results: We found significantly increased glutamine uptake in SLFN-/- EWS cells compared to WT.

Impact: Using 1H-MRS, we show that SLFN11 loss increases EWS reliance on glutamine, is different  than conventional glutamine metabolism typically observed in other cancers.

Keywords: Neonatal, Neuroscience

Motivation: Maternal nutrient intake is important for fetal growth and development. 

Goal(s): This study examined associations between maternal diet quality during pregnancy and neonatal brain white matter development.

Approach: Forty-four healthy pregnant woman/newborn dyads were included in the study. The mothers had nutrition intake assessed by Healthy Eating Index-2015 (HEI-2015) throughout pregnancy. Correlations between neonatal MRI diffusion tensor imaging (DTI)-measured fractional anisotropy (FA) and HEI-2015 scores were evaluated.

Results: Significant correlations between maternal sodium intake at 1^st trimester of pregnancy and neonatal white matter FA values were found, indicating potential influence of maternal sodium intake during early pregnancy on neonatal brain white matter development. 

Impact: We found significant correlations between maternal sodium intake at first trimester of pregnancy and neonatal DTI-measured FA values, indicating sodium intake better aligned with the Dietary Guidelines of Americans during early pregnancy is associated with better neonatal white matter development.

Keywords: Normal Development, Pediatric, Diagnosis; Precocious puberty.

Motivation: Gonadotropin-releasing hormone (GnRH) stimulation test is time- and labor- consuming. A prediction model composed of MRI-derived variables for precocious puberty is useful for diagnosis.

Goal(s): This study aimed to evaluate the diagnostic value of adenohypophyseal MRI features for precocious puberty in girls.

Approach: Pearson correlation and stepwise multivariate linear regression analysis were used to examine the best association of MRI features and clinical data for 126 girls and build prediction models.

Results: Two Models were built to predict LH and LH/FSH. ROC analysis showed the predicted LH, predicted LH/FSH, and aPV were the top 3 best predictors in distinguishing CPP group from controls.

Impact: The adenohypophysis volume itself and the prediction models including main adenohypophyseal MRI features increased diagnosis efficiency for PP and offered a non-invasive and credible diagnostic method.

Keywords: Neonatal, Brain

Motivation: Few research has reported the differences of the T1, T2* and proton density (PD) values of multi-parametric magnetic resonance (MR) between healthy preterm and term neonates.

Goal(s): To evaluate T1, T2* and PD mapping of preterm and term neonate in the deep gray matter.

Approach: We performed MRI on a 3.0T MR scanner (Omega, United Imaging Health Care) using multi-parametric MR imaging with flexible design (MULTIPLEX) transverse axis sequence.

Results: T1 relaxation time showed significant differences in bilateral putamen (PT) and pallidus (GP) between preterm and term newborns and was negative correlated with gestational age (GA).

Impact: Our study demonstrated that the T1 relaxation time in deep gray matter nuclei decreased with GA, and the preterm showed higher T1 relaxation values than the term neonate in PT and GP at term equivalent age.

Keywords: Adolescents, Endocrine

Motivation: The role of age in hypothalamic-pituitary-gonadal axis (HPG axis) reactivation on brain changes in girls remains unclear.

Goal(s): The aim of this study was to analyze the effects of HPG axis reactivation on the brains of girls of different ages through a multimodal perspective.

Approach: We used linked independent component analysis to decompose the girls' multimodal brain images and combined clinical hormones and age.

Results: We captured a multimodal component strongly associated with HPG reactivation, which includes structural and functional changes, mainly related to peak LH levels. Also, the degree of change in this multimodal component increased with age.

Impact: Our study may provide a new idea for subsequent brain studies concerning the reactivation of the HPG axis and a new direction for further exploration of the physiological mechanisms associated with pubertal brain development.

Keywords: Prenatal, Fetus, gyrification, fetal growth restriction

Motivation: Fetal growth restriction (FGR) is highly associated with adverse outcomes. While reduced brain volume is associated with FGR, knowledge regarding cortical developmental is scarce.

Goal(s): We aimed to quantitatively assess differences in brain volumes and cortical folding patterns between FGR and appropriate-for gestational-age (AGA) fetuses, and between FGR with normal and abnormal pulsatile-index (PI) measured by Doppler-US in the middle-cerebral-artery (MCA).

Approach: Gyrification and brain volume were computed using an automatic method based on T₂-weighted MRI.

Results: Significant reduction of brain volume and gyrification were detected in FGR compared with AGA, and in gyrification in fetuses with abnormal MCA-PI.

Impact: Reduced gyrification in FGR fetuses can offer insights into the pathomechanism linking abnormal MCA-PI, cortical development, and postnatal outcomes. This may enable marker for assessing the severity of restriction and facilitate pregnancy management by determining the optimal time for delivery.

Keywords: Cardiovascular, Heart

Motivation: Interventional cardiac MRI (iCMR) can be used to guide catheterizations, but image quality is limited by real-time imaging constraints (acquisition/reconstruction times).  

Goal(s): To evaluate the extent to which real-time multi-shot imaging (via adaptive radial k-space sampling, ARKS) improves iCMR image quality relative to single-shot imaging.  

 

Approach: Both ARKS and golden angle radial sampling were simulated using pediatric ECG recordings. Image quality was evaluated via mean squared error (MSE) and structural similarity index metric (SSIM). 

Results: ARKS increases the number of samples available for reconstruction, relative to single shot imaging with the same temporal footprint. This led to lower MSE and higher SSIM.

Impact: Multi-shot real-time imaging has the potential to significantly improve interventional imaging by increasing the amount of data available for image reconstruction. In this study, we demonstrate that combining multi-shot data can improve image quality. 

Keywords: Cardiovascular, Cardiovascular

Motivation: 4D Flow Assessment for Reconstruction Right Ventricular Outflow Tract in Congenital Heart Disease Patients: New Hemodynamic Insights for Handmade Three-Valve Goretex Conduit

Goal(s): 1) evaluate pulmonary valve regurgitation and the patency of the Goretex conduit using 4D flow CMR compare with controls. 2) assess the variation of advanced hemodynamic parameters of 2D axial WSS, 2D circumference WSS and EL in Gortex conduit.

Approach:   The CMR data was acquired from 12 healthy participants and 17 patients who were performed cine sequence in routine chamber view and 4D flow.

Results:  Hemodynamic changes were detected in patients with right ventricular outflow tract reconstruction.

Impact: Further long-term evaluation is necessary for the changes in segmental WSS in MPA.

Keywords: Cardiovascular, Pediatric, Multidimensional Flow Imaging

Motivation: In the absence of injected contrast agent, the quality of magnitude data from traditional 4D flow techniques can be poor, making structural visualization and blood vessel segmentation challenging.

Goal(s): Slice-to-volume 4D flow data has inherently high signal in blood vessels owing to in-flow effects. We apply slice-to-volume 4D flow in pediatric patients and evaluate its accuracy.

Approach: 7 pediatric patients were imaged with slice-to-volume 4D flow. Dynamic magnitude reconstructions and angiograms were assessed. The flow accuracy was evaluated using traditional 2D phase contrast MRI.

Results: Slice-to-volume 4D flow provided accurate flow quantification along with high quality anatomical and angiographic visualisations without contrast injection.

Impact: Volumetric flow imaging was performed using slice-to-volume 4D flow in pediatric patients. The technique provided accurate flow quantification along with high quality anatomical and angiographic visualisations without contrast injection.

Keywords: Cardiovascular, Data Acquisition, congenital heart disease, morphology, function

Motivation: 3D dual-phase whole-heart MRI has shown advantage for simultaneous morphological and functional cardiac imaging but is so far not available at 3.0T due to bSSFP susceptibility artifacts and specific absorption rate limitation at high field.

Goal(s): Our goal was to develop a new sequence to circumvent the problems and allow 3D dual-phase whole-heart MRI for high-field cardiac imaging.

Approach: We implemented an interleaved cardiac-triggered acquisition with non-balanced readout and applied it in patients with congenital heart disease at 3.0T.

Results: 3D dual-phase whole-heart MRI at 3.0T successfully depicted morphological and functional changes within one single scan in concordance with standard techniques.

Impact: 3D isotropic dual-phase whole-heart MRI with interleaved ECG-triggered acquisition and non-balanced readout now permits visualization and assessment of cardiac morphology and function with high resolutions within one single scan at 3.0T and promises wider clinical applications in congenital heart disease.

Keywords: Cardiovascular, Blood vessels

Motivation: Signal loss in non-contrast-enhanced thoracic MRI due to off-resonance artifacts precludes evaluation of pulmonary vessels, particularly in children with complex/turbulent flows at high field.

Goal(s): Our goal was to restore the signal and reduce artifacts for improved visualization of pulmonary vessels at 3.0T.

Approach: We introduced a T2prep pulse with 16 composite refocusing pulses “MLEV16” with shorter refocusing interval and applied it in patients with congenital heart disease at 3.0T, in comparison to standard T2prep pulse using MLEV4.

Results: Visualization of the pulmonary vessels was clearly improved using the MLEV16 pre-pulse compared to standard MLEV4 T2prep at 3.0T.

Impact: Non-contrast-enhanced thoracic MRI with MLEV16 pre-pulse for T2 preparation permits improved visualization of pulmonary vessels for clinical evaluation, a primary need in areas where pediatric congenital heart disease is common and high-field MRI at 3.0T becomes more accessible.

Keywords: Cardiovascular, Cardiomyopathy, Dilated cardiomyopathy; late gadolinium enhancement

Motivation: The prognostic value of late gadolinium enhancement (LGE) in adult dilated cardiomyopathy (DCM) has been confirmed, but its prognostic value in children with DCM remains unclear.

Goal(s): To evaluate the prognostic value of late LGE in children with DCM. 

Approach: This retrospective single-center study analyzed 76 children with DCM. The composite endpoint was all-cause mortality, heart transplant, and rehospitalization for heart failure. The risk factors for the composite endpoint were identified with multivariable Cox analysis.

Results: Multivariable Cox analysis showed that LGE present was associated with the composite endpoints (hazard ratio [HR], 2.59 [95% CI: 1.05, 6.37], p=0.039).

Impact:  Late gadolinium enhancement of CMR in children with DCM provides independently prognostic value of all-cause mortality, heart transplant, and rehospitalization for heart failure.

Keywords: Cardiovascular, Cardiomyopathy

Motivation: Duchenne muscular dystrophy (DMD) leads to pediatric cardiomyopathy. Pre-contrast T1 in DMD identifies myocardial remodeling, but it remains unclear if T1-Mapping biomarkers can detect longitudinal changes in DMD.

Goal(s): The objective was to characterize progressive myocardial pre-contrast T1 changes in DMD at 3T.

Approach: Boys with DMD and healthy controls underwent a 3T CMR exam that included standard functional and pre-contrast T1 mapping sequences. Boys with DMD were examined at two points (18 months apart). 

Results: Pre-contrast T1 was capable of detecting progressive changes in boys with DMD 18 months post baseline while functional metrics like LVEF did not.

Impact: T1 Mapping biomarkers can detect disease progression in DMD. T1 Mapping biomarkers, in combination with biomarkers of function have the potential to track patient-specific changes. 

Keywords: Flow, Surgery, Congenital heart disease

Motivation: The descending aorta (DAo) in patients with hypoplastic left heart syndrome (HLHS) after Norwood procedure is frequently enlarged although this region is not subject to surgical procedures.

Goal(s): The aim of this study is to investigate whether the aortic anatomy can cause abnormal flow patterns which are related to vascular alterations. 

Approach: Based on anatomic models and flow boundaries from 4D flow MRI, we studied fluid-dynamics using CFD simulations. 
 

Results: We found increased vorticity and wall-shear stress in the HLHS descending aorta. Increased wall shear stress has been associated with the development of dilation and may explain vascular alterations in the descending aorta.

Impact: This study gives motivation for further investigations and may ultimately lead to future Norwood procedure modifications.

Keywords: Flow, Vessels

Motivation: Aortic coarctation (COA) is a congenital heart disease that induces harmful structural cardiovascular changes. Operations to address COA have varying outcomes, leaving uncertainty as to whether maladaptive processes can be altered. Despite repair, patients have an increased risk of early cardiovascular morbidity and mortality.

Goal(s): To utilize 4D Flow MRI to monitor and study the vascular biomechanics of aortic coarctation in a porcine model

Approach: In this pilot study, a porcine model of aortic coarctation was developed and underwent serial 4D flow MRI scans.

Results: Treatment did not significantly alter quantitative metrics of aortic flow, velocity or collateralization

Impact: 4D Flow MRI provides a non-invasive method to evaluate a novel porcine model of aortic coarctation with resultant functional metrics that provide insight into the significant early remodeling and lack of early treatment efficacy in this patient population.

Keywords: Heart Failure, Cardiovascular

Motivation: The triad of pulmonary hypoplasia, pulmonary hypertension, and early cardiac dysfunction has been postulated to be responsible for poor postnatal outcomes in congenital diaphragmatic hernia repair (CDH). 

Goal(s): This study was aimed to investigate whether MRI markers of cardiac dysfunction are associated with clinical outcomes in neonates after CDH.

Approach: In this prospective study neonates after CDH repair underwent 3T cardiac MRI. Biventricular function/volumes, end-diastolic/end-systolic volumes, shunt fraction were assessed.  The study cohort was binarized based on median RVEF (cutoff >54%) to compare clinical variables and outcome data between two groups.

Results: MRI-derived parameters of RV-dysfunction were associated with short-term clinical outcomes. 

Impact: Cardiac MRI allows for objective and early assessment of cardiac dysfunction and, hence, might play an important role in risk stratification and clinical decision-making in neonates after CDH repair.

Keywords: Cardiovascular, Pediatric, Cardiac Implantable Electronic Devices, Real-Time Cine, Wideband, Pulse Sequence, Perfusion, LGE

Motivation: Cardiac MRI is rarely performed in children with cardiac implantable electronic devices (CIED) due to safety concerns and image artifacts.

Goal(s): To determine the clinical utility of wideband cardiac, real-time MRI methods in children with an implantable pulse generator (IPG). 

Approach: We performed free-breathing real-time cine, wideband late gadolinium enhancement (LGE) and perfusion in 18 healthy children with IPG taped to below the left clavicle and abdomen to mimic endocardial and epicardial systems, respectively.

Results: Compared to the standard, wideband sequences effectively suppressed image artifacts, and produced relatively accurate quantification of bi-ventricular functional metrics.

Impact: Wideband cardiac, real-time pulse sequences are effective in reducing image artifacts induced by an IPG, thereby increasing the potential benefit of cardiac MRI in children with CIEDs.

Keywords: Fetal, Low-Field MRI, Fetal Cardiac MRI

Motivation: Low field MRI at 0.55T offers advantages such as increased field homogeneities for fetal cardiac MRI and early diagnosis of congenital heart diseases (CHDs) but required careful optimization specific to the properties of low field.

Goal(s): This study aimed to optimize the bSSFP sequence parameters at 0.55T to compensate for the reduced SNR and improve diagnostic capabilities in fetal cardiac MRI.

Approach: Phantom experiments and in-utero studies were conducted to evaluate the impact of optimized parameters of bSSFP sequences on SNR, image quality, and clinical applicability.

Results: The optimized bSSFP sequence parameters demonstrate increased SNR and good visualization of cardiac structures.

Impact: The optimized bSSFP sequence at 0.55T has the potential to be used at low field strengths to prenatally diagnose congenital heart disease, thereby increasing accessibility for patients.

Keywords: Fetal, Fetus

Motivation: To allow diagnosis of CHD at low field strengths in order to increase the accessibility of MRI.

Goal(s): To demonstrate that acquiring 2D phase contrast sequences in utero at 0.55T is possible. 

Approach: Acquire 2D Phase contrast sequences, optimize sequences parameters, and perform metric optimized gating and flow measurements

Results: Umbilical vein, descending aorta, and superior vena cava flow in utero measurements were calculated.

Impact: Fetal flow measurements provide additional information on the complex hemodynamics in complex CHD cases – potentially enhancing antenatal counselling and postnatal surgery planning.  Optimizing these for emerging low field MRI scanners widens their availability.

Keywords: Prenatal, Fetus

Motivation: A novel pipeline for the creation of 3D fetal whole-heart datasets has been devised by combining Doppler US-gating and slice-to-volume registration. 

Goal(s): Our goal was to perform initial validation of the resultant 3D+t datasets.

Approach: We assessed for internal consistency by deriving fetal stroke volume data from two methods in six subjects. Stroke volume data were obtained through volumetric analysis of the 3D+t volume alongside assessment of paired 2D+t phase-contrast flow data.

Results: There was correlation between volumetrically derived stroke-volume data with that derived from 2D+t phase contrast flow, however the volumetric method was biased toward lower readings.

Impact: Initial validation of a novel pipeline for the creation 3D fetal whole-heart datasets shows correlation between stroke volumes derived from volumetry and phase contrast flow data. Future work will explore the bias toward lower stroke volumes obtained by volumetry.

Keywords: Flow, Fetus, 4D flow

Motivation: Small blood vessel size relative to spatial resolution in fetal 4D flow MRI makes segmentation and flow quantification difficult. 

Goal(s): To quantify blood flow from fetal 4D flow using black blood imaging-based segmentation and to compare hemodynamic results to 4D flow-only approach. We hypothesize black blood will provide better flow delineation for complex anatomies. 

Approach: The great vessels were segmented from 4D flow and black blood for volunteers and coarctation cases; flow volumes were compared after alignment of segmentations.

Results: Black blood underestimated flow volume but captured vessel geometry and flow features 4D flow segmentation missed in several cases of coarctation.

Impact: While the combination of black blood imaging and fetal 4D flow did not offer flow quantification comparable to conventional 4D flow approach, its potential of capturing coarctation flow may assist prenatal diagnosis of coarctation, which is challenging solely with ultrasound. 

Keywords: Fetal, Fetus, 4D flow

Motivation: Fetal 4D flow provides useful information related to cardiovascular structure and function, but its reliability is not yet defined.

Goal(s): Here, we seek to define the accuracy, precision, internal consistency, and repeatability of fetal 4D flow.

Approach: Pregnant women in their third trimester with healthy developing fetuses (N=22) and fetuses with suspected cardiovascular anomalies (N=12) were scanned with 2D phase contrast and 4D flow sequences. Quantitative flow metrics were compared.

Results: 4D flow underestimated net flow in the great vessels relative to 2D-PC, but had reasonable precision, internal consistency, and repeatability. Fetal 4D flow can reliably measure percentage contributions from various vascular territories.

Impact: Fetal 4D flow allows for quantitative hemodynamic evaluation of the fetal cardiovascular system with good precision, internal consistency, and repeatability. Flow was underestimated relative to 2D-PC, therefore presently percent contribution from various vascular territories is the most appropriate clinical endpoint.