Diagnostic and therapeutic value of magnetic resonance imaging in children. A single-center retrospective cohort study

Background: The use of clinical imaging in pediatric patients has expanded significantly over the last decades. Particularly in younger age groups, some form of sedation is often required to perform the time-consuming scan. Providing anesthesia to children, specifically within the MRI suite, poses certain risks. This study aims to analyze the indications and therapeutic consequences of pediatric MRI procedures, along with potential adverse effects of both MRI procedure and general anesthesia in this patient population. As a final outcome, this study aims to provide a cost-benefit analysis of pediatric MRI in terms of patient safety, diagnostic value and resulting potential therapeutic consequences . Methods: This study was conducted as a retrospective longitudinal data analysis in a single secondary care hospital. Data were collected for all children (aged 6 months to 16 years) undergoing MRI under general anesthesia at our hospital. The time frame for data collection was November 2016, the start of our program, through March 2023. The primary and key secondary outcome are the diagnostic value and the therapeutic value of pediatric MRI, respectively. Secondary outcomes include the anatomical regions undergoing imaging, adverse events related to anesthesia or MRI procedure, including hospital admissions, and the impact of the COVID pandemic on the primary and key secondary outcome. Results: During the study period (November 2016 - March 2023) a total of 437 MRI scans were performed under general anesthesia. The primary indication of MRI was the exclusion of intracranial abnormalities (n=321; 73.5%). The most frequent pre-existing symptoms were developmental delay (n=143; 32,72%) and other symptoms (n=153; 35%). MRI resulted in a diagnosis for 70 patients (16%), and treatment changes occurred after 33 MRIs (7,6%). During the COVID-19 pandemic, with restricted indication for MRI, the diagnostic and therapeutic value of pediatric MRI increased significantly to 37.3% (p<0,001) and 14,5% (p<0,01) respectively. No post-procedural serious adverse effects of general anesthesia or MRI were reported in the medical files. Conclusions: MRI remains a viable tool for diagnostics in the pediatric population. Sedation or general anesthesia enables accurate and reliable imaging in cases where patient cooperation is challenging. However, redefining indications might improve resource allocation and prevent futile interventions.