{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T07:08:06Z","timestamp":1770275286670,"version":"3.49.0"},"reference-count":35,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T00:00:00Z","timestamp":1770163200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Young children requiring neurosurgical care frequently undergo repeated neuroimaging. Whereas CT involves exposure to ionizing radiation, conventional MRI is time-consuming and often necessitates sedation in non-cooperative children. To address these limitations, ultrafast cranial MRI (UF-MRI) based on T2-HASTE sequences was implemented at our institution in 2019 for selected indications. The aim of this study was to evaluate the real-world implementation of UF-MRI in children younger than six years of age. Methods: We retrospectively analyzed cranial MRI examinations consisting exclusively of ultrafast sequences performed between July 2019 and December 2024 in children younger than six years. Clinical settings, diagnostic adequacy, immediate consequences for patient management, and the impact on MRI and CT utilization were systematically assessed. Results: A total of 404 UF-MRI examinations were performed in 198 inpatients and outpatients (mean age: 2 years 2 months) without the need for dedicated anesthesia team support solely for imaging. Only one examination (0.2%) required same-day repetition after mild oral sedation. In 20 patients (5.0%), UF-MRI was supplemented by conventional MRI under anesthesia, most commonly for preoperative planning. Immediate clinical consequences included no change in management in 54.5% of examinations, early follow-up in 22.8%, shunt valve adjustment in 11.6%, neurosurgical intervention in 7.7%, and other measures in 5.0%. UF-MRI accounted for 24.5% of all cranial MRI examinations in this age group and was associated with a 41% reduction in CT utilization compared with the corresponding period prior to UF-MRI implementation. Conclusions: In routine clinical practice, UF-MRI provides rapid, clinically sufficient neuroimaging in young children without the need for sedation or exposure to ionizing radiation. Its implementation significantly streamlines imaging workflows, optimizes resources utilization, reduces the need for CT, and supports timely clinical decision-making, underscoring its value as a complementary imaging modality in pediatric neuroimaging.<\/jats:p>","DOI":"10.3390\/jcm15031242","type":"journal-article","created":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T17:20:14Z","timestamp":1770225614000},"page":"1242","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Impact of Ultrafast Cranial MRI Implementation in Children Under Six Years of Age"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6149-8568","authenticated-orcid":false,"given":"Rastislav","family":"Pjontek","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University Hospital RWTH Aachen, 52074 Aachen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5195-614X","authenticated-orcid":false,"given":"Hani","family":"Ridwan","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, 52074 Aachen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benedikt","family":"Kremer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital RWTH Aachen, 52074 Aachen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3648-6842","authenticated-orcid":false,"given":"Michael","family":"Veldeman","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital RWTH Aachen, 52074 Aachen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2958-1059","authenticated-orcid":false,"given":"Dimah","family":"Hasan","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, 52074 Aachen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8433-8919","authenticated-orcid":false,"given":"Martin","family":"H\u00e4usler","sequence":"additional","affiliation":[{"name":"<sup>3<\/sup> Division of Neuropediatrics and Social Pediatrics, Department of Pediatrics, University Hospital RWTH Aachen, 52074 Aachen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8261-5513","authenticated-orcid":false,"given":"Martin","family":"Wiesmann","sequence":"additional","affiliation":[{"name":"Department of Diagnostic and Interventional Neuroradiology, University Hospital RWTH Aachen, 52074 Aachen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8258-9346","authenticated-orcid":false,"given":"Hans","family":"Clusmann","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital RWTH Aachen, 52074 Aachen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hussam","family":"Hamou","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University Hospital RWTH Aachen, 52074 Aachen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1148\/radiol.10091124","article-title":"Effect of Anesthesia and Sedation on Pediatric MR Imaging Patient Flow","volume":"256","author":"Vanderby","year":"2010","journal-title":"Radiology"},{"key":"ref_2","unstructured":"Sandhu, P.K., Banker, H., and Cohen, H.L. (2025, August 21). Neurosonography Assessment, Protocols, and Interpretation, StatPearls, Available online: http:\/\/www.ncbi.nlm.nih.gov\/books\/NBK573073\/."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3111","DOI":"10.1038\/s41591-023-02620-0","article-title":"Risk of hematological malignancies from CT radiation exposure in children, adolescents and young adults","volume":"29","author":"Harbron","year":"2023","journal-title":"Nat. Med."},{"key":"ref_4","first-page":"155932582092382","article-title":"Radiation Exposure Associated with Computed Tomography in Childhood and the Subsequent Risk of Cancer: A Meta-Analysis of Cohort Studies","volume":"18","author":"Huang","year":"2020","journal-title":"Dose-Response"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1093\/jnci\/djy104","article-title":"Radiation Exposure From Pediatric CT Scans and Subsequent Cancer Risk in the Netherlands","volume":"111","author":"Meulepas","year":"2019","journal-title":"JNCI J. Natl. Cancer Inst."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00411-014-0580-3","article-title":"Risk of cancer incidence before the age of 15 years after exposure to ionising radiation from computed tomography: Results from a German cohort study","volume":"54","author":"Krille","year":"2015","journal-title":"Radiat. Environ. Biophys."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1001\/jamapediatrics.2013.311","article-title":"The Use of Computed Tomography in Pediatrics and the Associated Radiation Exposure and Estimated Cancer Risk","volume":"167","author":"Miglioretti","year":"2013","journal-title":"JAMA Pediatr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1851","DOI":"10.3174\/ajnr.A3076","article-title":"Strengthening the Argument for Rapid Brain MR Imaging: Estimation of Reduction in Lifetime Attributable Risk of Developing Fatal Cancer in Children with Shunted Hydrocephalus by Instituting a Rapid Brain MR Imaging Protocol in Lieu of Head CT","volume":"33","author":"Koral","year":"2012","journal-title":"Am. J. Neuroradiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"147","DOI":"10.3171\/ped.2004.101.2.0147","article-title":"The use of quick-brain magnetic resonance imaging in the evaluation of shunt-treated hydrocephalus","volume":"101","author":"Iskandar","year":"2004","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1055\/a-1561-2430","article-title":"Decreased Need for Anesthesia during Ultra-Fast Cranial MRI in Young Children: One-Year Summary","volume":"194","author":"Sorge","year":"2022","journal-title":"R\u00f6Fo-Fortschritte Auf Dem Geb. R\u00f6ntgenstrahlen Bildgeb. Verfahr."},{"key":"ref_11","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_12","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_13","doi-asserted-by":"crossref","first-page":"413","DOI":"10.2214\/AJR.16.16870","article-title":"Neuroimaging of Children with Surgically Treated Hydrocephalus: A Practical Approach","volume":"208","author":"Robson","year":"2017","journal-title":"Am. J. Roentgenol."},{"key":"ref_14","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: Clinical article","volume":"13","author":"Thompson","year":"2014","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_15","first-page":"1515","article-title":"Ultrafast Brain MRI Can Be Used for Indications beyond Shunted Hydrocephalus in Pediatric Patients","volume":"39","author":"Tekes","year":"2018","journal-title":"Am. J. Neuroradiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1007\/s00247-019-04506-1","article-title":"Implementation of a brain injury screen MRI for infants at risk for abusive head trauma","volume":"50","author":"Berger","year":"2020","journal-title":"Pediatr. Radiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"807","DOI":"10.3174\/ajnr.A5093","article-title":"Diagnostic Performance of Ultrafast Brain MRI for Evaluation of Abusive Head Trauma","volume":"38","author":"Kralik","year":"2017","journal-title":"Am. J. Neuroradiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e660","DOI":"10.1097\/PEC.0000000000002089","article-title":"The Use of Rapid Sequence Magnetic Resonance Imaging of the Brain as a Screening Tool for the Detection of Gross Intracranial Pathology in Children Presenting to the Emergency Department with a Chief Complaint of Persistent or Recurrent Headaches","volume":"37","author":"Luque","year":"2021","journal-title":"Pediatr. Emerg. Care"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"114099","DOI":"10.1016\/j.jpeds.2024.114099","article-title":"Increasing Use of Rapid Magnetic Resonance Imaging for Children with Blunt Head Injury","volume":"272","author":"Burns","year":"2024","journal-title":"J. Pediatr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e1168","DOI":"10.1097\/PEC.0000000000001949","article-title":"Fast Brain Magnetic Resonance Imaging with Half-Fourier Acquisition with Single-Shot Turbo Spin Echo Sequence in Detection of Intracranial Hemorrhage and Skull Fracture in General Pediatric Patients: Preliminary Results","volume":"37","author":"Kabakus","year":"2021","journal-title":"Pediatr. Emerg. Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e20190419","DOI":"10.1542\/peds.2019-0419","article-title":"Feasibility and Accuracy of Fast MRI Versus CT for Traumatic Brain Injury in Young Children","volume":"144","author":"Lindberg","year":"2019","journal-title":"Pediatrics"},{"key":"ref_22","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_23","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1007\/s00234-016-1686-x","article-title":"Rapid MRI evaluation of acute intracranial hemorrhage in pediatric head trauma","volume":"58","author":"Ryan","year":"2016","journal-title":"Neuroradiology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1002\/emp2.12113","article-title":"Can QuickBrain MRI replace CT as first-line imaging for select pediatric head trauma?","volume":"1","author":"Sheridan","year":"2020","journal-title":"JACEP Open"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"475","DOI":"10.3171\/2020.8.PEDS20496","article-title":"Utility of a pediatric fast magnetic resonance imaging protocol as surveillance scanning for traumatic brain injury","volume":"27","author":"Shope","year":"2021","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"75","DOI":"10.3348\/kjr.2024.0725","article-title":"Ultrafast MRI for Pediatric Brain Assessment in Routine Clinical Practice","volume":"26","author":"Moon","year":"2025","journal-title":"Korean J. Radiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"747","DOI":"10.2214\/AJR.22.28490","article-title":"Pediatric Outpatient Noncontrast Brain MRI: A Time-Driven Activity-Based Costing Analysis at Three U.S. Hospitals","volume":"220","author":"Hayatghaibi","year":"2023","journal-title":"Am. J. Roentgenol."},{"key":"ref_28","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_29","doi-asserted-by":"crossref","first-page":"440","DOI":"10.3171\/2014.1.PEDS13447","article-title":"Fast-sequence MRI studies for surveillance imaging in pediatric hydrocephalus","volume":"13","author":"Patel","year":"2014","journal-title":"J. Neurosurg. Pediatr."},{"key":"ref_30","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_31","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1007\/s10143-023-02084-3","article-title":"Combined rapid sequence MRI protocol and skull radiography as an alternative to head CT in the evaluation of abusive head trauma in children: A pilot study","volume":"46","author":"Franklin","year":"2023","journal-title":"Neurosurg. Rev."},{"key":"ref_32","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. BMC Pediatr., 20.","DOI":"10.1186\/s12887-020-1919-3"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"198","DOI":"10.2214\/AJR.19.22378","article-title":"One-Minute Ultrafast Brain MRI with Full Basic Sequences: Can It Be a Promising Way Forward for Pediatric Neuroimaging?","volume":"215","author":"Ha","year":"2020","journal-title":"Am. J. Roentgenol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1751","DOI":"10.1007\/s00247-020-04771-5","article-title":"Outpacing Movement\u2014Ultrafast Volume Coverage in Neuropediatric Magnetic Resonance Imaging","volume":"50","author":"Roth","year":"2020","journal-title":"Pediatr. Radiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"343","DOI":"10.3171\/2023.11.PEDS23412","article-title":"Rapid brain MRI for image-guided ventricular catheter placement in pediatric patients: Protocol and preliminary clinical outcomes","volume":"33","author":"Lai","year":"2024","journal-title":"J. Neurosurg. Pediatr."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/3\/1242\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,4]],"date-time":"2026-02-04T17:34:04Z","timestamp":1770226444000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/3\/1242"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,4]]},"references-count":35,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["jcm15031242"],"URL":"https:\/\/doi.org\/10.3390\/jcm15031242","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,4]]}}}