Purpose or Case Report: Purpose:
CT is the default for many pediatric lung questions, yet MRI is radiation-free but still can answer the clinical problem and is preferable forfor children needing serial follow-up. This exhibit provides an indication-driven, clinically usable guide for when MRI should replace, complement, or defer to CT and an overview of sequences and areas needing r further research.
Clinical applications:
Children who undergo repeated imaging accrue radiation. In the right scenarios, MRI enables tighter follow-up intervals, captures dynamic airway/diaphragm abnormalities that static CT may miss, and combines soft-tissue and vascular assessment in a single visit. Clinical applications where MRI may add value:
- Longitudinal parenchymal and airway assessment in broncho-pulmonary dysplasia (BPD), chronic lung disease, cystic fibrosis (CF), bronchiolitis obliterans (BO): radiation-free monitoring with morphology + functional surrogates
- Dynamic disorders: cine/real-time MRI for tracheo/bronchomalacia and diaphragm dysfunction, offering a radiation-free complement to bronchoscopy or CT.
- Congenital lesions & vascular anomalies: single-session MRI/MRA road-mapping (CPAM, sequestration; rings/slings).
- Transplant/oncology surveillance: safer serial monitoring when cumulative CT exposure reduction is desirable.
MRI sequence essentials:
3D UTE (stack-of-spirals / radial “kooshball”): improved lung signal and motion robustness for free-breathing isotropic morphology; helpful in neonates and toddlers, though spatial resolution remains lower than CT.
- Standard T2 (2D/3D TSE): edema, secretions, pleura/mediastinum.
- PREFUL (free-breathing 1H V/Q surrogate): non-contrast regional ventilation/perfusion maps, correlates with hyperpolarized-Xe metrics; promising for CF/BO/BPD trends and therapy response.
- Hyperpolarized 129Xe MRI: sensitive quantitative ventilation/gas-transfer metrics; consider for advanced CF or as a research reference.
- Breathing strategy: default free-breathing for UTE/PREFUL; add navigator/self-nav for longer 3D blocks; brief breath-holds in older kids for targeted T2/cine.
Teaching points:
While MRI cannot universally replace lung CT, it provides actionable, radiation-free information in selected conditions that changes management. Clear indications, streamlined workflows, and structured reporting enable adoption now, while targeted research will standardize when MRI should lead, complement, or defer to CT.
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