A retrospective comparison of image quality in T2-weighted paediatric brain MRI using Children- centred Care versus anaesthesia

Introduction: Magnetic Resonance Imaging (MRI) is the preferred modality for evaluating paediatric brain conditions due to its superior soft tissue contrast and absence of ionising radiation. However, children often require general anaesthesia (GA) to prevent motion artefacts, leading to increased waiting times and costs. The Children-centred Care (CCC) approach reduces the need for GA, but its potential impact on image quality has not been scientifically evaluated. Methods: This retrospective cohort study included children aged 3–6 years who underwent brain MRI with or without GA in a clinical setting. Three observers performed a Visual Grading Analysis (VGA) to assess image quality on T2-weighted MRIs. The Mann–Whitney U test was used for statistical analysis, and intra- and inter-observer agreement was evaluated using Cohen's and Fleiss' kappa tests. Results: A total of 70 brain MRIs from 68 children were included, with 22 in the GA group and 48 in the CCC group. Image quality scores were significantly higher in the GA group (mean VGA 4.32 vs. 3.71, p < 0.001). Intra-observer reliability ranged from substantial to perfect (κw = 0.64–0.84), and inter-observer agreement was fair (κ = 0.32). Slice thickness differed slightly with thinnest slices in the GA group (p < 0.001). Conclusion: T2-weighted paediatric brain MRI under GA showed superior image quality compared to CCC. However, most CCC images were clinically acceptable, suggesting focus on balancing image quality with GA avoidance. Future studies are warranted. Implications for practice: VGA provides a structured approach to assessing image quality and could form the basis for developing standardised paediatric brain MRI criteria. These findings support CCC as a feasible, patient-centred alternative that reduces anaesthesia use, risks and costs, while enhancing the overall patient experience.