{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T18:13:29Z","timestamp":1779387209408,"version":"3.53.1"},"reference-count":22,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Objective: Rapid-sequence magnetic resonance imaging (rMRI) has emerged as a radiation-free alternative to computed tomography (CT) in pediatric neuroimaging. This study aimed to evaluate the diagnostic utility, clinical consequences, and subgroup-specific differences in pediatric patients undergoing rMRI for emergency neurosurgical indications. Methods: We conducted a retrospective, single-center study of 158 rMRIs in 73 pediatric patients who underwent rMRI between January 2017 and December 2023 due to suspected complications of hydrocephalus and brain tumors. A short MRI protocol (195 s) including FLAIR BLADE and T2 HATSE sequences was employed. Patients were categorized into tumor non-related and tumor-related hydrocephalus groups. Results: A total of 158 rMRIs in 73 pediatric patients were included. The mean age was 7.09 \u00b1 4.63 years, with 69.6% male patients. Ventricular size monitoring was the most common rMRI indication (96.2%). Clinical consequences followed in 52.5% of cases, including surgical interventions (21.5%) and shunt valve adjustments (37.3%). Sedation was required in only 5.1% of patients. Only 1.9% required follow-up CT. Statistically significant intergroup differences were found in drainage type (p &lt; 0.001), diagnosis (p &lt; 0.001), and need for follow-up MRI (17.4% in the tumor-related hydrocephalus group vs. 4.5% in the tumor non-related hydrocephalus group; p = 0.014). Conclusions: rMRI is a safe, efficient, and effective alternative to CT for emergency neuroimaging in pediatric patients with hydrocephalus, tumors, or shunts. It facilitates timely clinical decision-making while avoiding radiation exposure. Our findings support broader implementation of rMRI protocols, particularly for patients requiring ongoing tumor surveillance.<\/jats:p>","DOI":"10.3390\/children13050699","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T16:46:18Z","timestamp":1779381978000},"page":"699","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Utility of Rapid-Sequence Magnetic Resonance Imaging (rMRI) in Pediatric Neurosurgery: Enhancing Assessment of Hydrocephalic Changes"],"prefix":"10.3390","volume":"13","author":[{"given":"Johanna","family":"Kr\u00e4mer","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Hospital University Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany"},{"name":"Faculty of Medicine, Heidelberg University, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nieke","family":"Ueding","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital University Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany"},{"name":"Faculty of Medicine, Heidelberg University, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-2691-1312","authenticated-orcid":false,"given":"Christian","family":"Ott","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Heidelberg University, 69120 Heidelberg, Germany"},{"name":"Department of Neuroradiology, Hospital University Heidelberg, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelika","family":"Seitz","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Heidelberg University, 69120 Heidelberg, Germany"},{"name":"Department of Neuroradiology, Hospital University Heidelberg, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malte","family":"Ottenhausen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital University Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany"},{"name":"Faculty of Medicine, Heidelberg University, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4050-1531","authenticated-orcid":false,"given":"Sandro M.","family":"Krieg","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital University Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany"},{"name":"Faculty of Medicine, Heidelberg University, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0146-8943","authenticated-orcid":false,"given":"Ahmed","family":"El Damaty","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital University Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany"},{"name":"Faculty of Medicine, Heidelberg University, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7420-1647","authenticated-orcid":false,"given":"Mohammed","family":"Issa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital University Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany"},{"name":"Faculty of Medicine, Heidelberg University, 69120 Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e399","DOI":"10.1016\/j.wneu.2020.04.014","article-title":"National imaging trends in pediatric traumatic brain injury and hydrocephalus","volume":"139","author":"Harbert","year":"2020","journal-title":"World Neurosurg."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"George, E., and Barkovich, M.J. (2026). Pediatric Neuroimaging. Swaiman\u2019s Pediatric Neurology, Elsevier.","DOI":"10.1016\/B978-0-443-10944-7.00021-4"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1007\/s00381-019-04376-w","article-title":"Targeted head CT reduction for pediatric patients with hydrocephalus and traumatic brain injury: Academic center institutional experience as an example of opportunities for further improvement","volume":"36","author":"Harbert","year":"2020","journal-title":"Child\u2019s Nerv. Syst."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/S1470-2045(22)00655-6","article-title":"Brain cancer after radiation exposure from CT examinations of children and young adults: Results from the EPI-CT cohort study","volume":"24","author":"Hauptmann","year":"2023","journal-title":"Lancet Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1001\/jamainternmed.2025.0505","article-title":"Projected lifetime cancer risks from current computed tomography imaging","volume":"185","author":"Chu","year":"2025","journal-title":"JAMA Intern. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1097\/PEC.0000000000000227","article-title":"Imaging of pediatric head injury in the emergency department","volume":"30","author":"Wylie","year":"2014","journal-title":"Pediatr. Emerg. Care"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e47","DOI":"10.1542\/peds.2013-3739","article-title":"Comparison of rapid cranial MRI to CT for ventricular shunt malfunction","volume":"134","author":"Boyle","year":"2014","journal-title":"Pediatrics"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"11","DOI":"10.3174\/ajnr.A4464","article-title":"Minimizing radiation exposure in evaluation of pediatric head trauma: Use of rapid MR imaging","volume":"37","author":"Mehta","year":"2016","journal-title":"Am. J. Neuroradiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1007\/s00381-017-3385-2","article-title":"SSh versus TSE sequence protocol in rapid MR examination of pediatric patients with programmable drainage system","volume":"33","year":"2017","journal-title":"Child\u2019s Nerv. Syst."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1016\/j.ajem.2015.03.052","article-title":"Feasibility of \u201crapid\u201d magnetic resonance imaging in pediatric acute head injury","volume":"33","author":"Cohen","year":"2015","journal-title":"Am. J. Emerg. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.pediatrneurol.2019.08.001","article-title":"Utility of rapid sequence magnetic resonance imaging in guiding management of patients with neonatal seizures","volume":"103","author":"Czech","year":"2020","journal-title":"Pediatr. 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Pediatr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1016\/j.pediatrneurol.2019.12.007","article-title":"Rapid sequence MRI protocol in the evaluation of pediatric brain attacks","volume":"107","author":"Kannikeswaran","year":"2020","journal-title":"Pediatr. Neurol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1007\/s00247-015-3500-z","article-title":"Development of a screening MRI for infants at risk for abusive head trauma","volume":"46","author":"Flom","year":"2016","journal-title":"Pediatr. Radiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1269","DOI":"10.1056\/NEJMoa2502098","article-title":"Medical imaging and pediatric and adolescent hematologic cancer risk","volume":"393","author":"Alber","year":"2025","journal-title":"N. Engl. J. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1836","DOI":"10.3174\/ajnr.A3510","article-title":"Retrospective review of rapid pediatric brain MR imaging at an academic institution including practice trends and factors affecting scan times","volume":"34","author":"Niederhauser","year":"2013","journal-title":"Am. J. Neuroradiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"124","DOI":"10.3171\/ped.2005.103.2.0124","article-title":"Use of rapid-sequence magnetic resonance imaging for evaluation of hydrocephalus in children","volume":"103","author":"Ashley","year":"2005","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"636","DOI":"10.3171\/2014.2.PEDS13567","article-title":"Results of a North American survey of rapid-sequence MRI utilization to evaluate cerebral ventricles in children","volume":"13","author":"Thompson","year":"2014","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e307","DOI":"10.1016\/j.wneu.2012.10.066","article-title":"Rapid sequence magnetic resonance imaging in the assessment of children with hydrocephalus","volume":"80","author":"Pruthi","year":"2013","journal-title":"World Neurosurg."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Ramgopal, S., Karim, S.A., Subramanian, S., Furtado, A.D., and Marin, J.R. (2020). Rapid brain MRI protocols reduce head computerized tomography use in the pediatric emergency department. 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