Post-contrast T1-weighted sequences in pediatric abdominal imaging: comparative analysis of three different sequences and imaging approach

Background

Post-contrast T1-weighted imaging is an essential component of a comprehensive pediatric abdominopelvic MR examination. However, consistent good image quality is challenging, as respiratory motion in sedated children can substantially degrade the image quality.

Objective

To compare the image quality of three different post-contrast T1-weighted imaging techniques—standard three-dimensional gradient-echo (3-D-GRE), magnetization-prepared gradient-recall echo (MP-GRE) and 3-D-GRE with radial data sampling (radial 3-D-GRE)—acquired in pediatric patients younger than 5 years of age.

Materials and methods

Sixty consecutive exams performed in 51 patients (23 females, 28 males; mean age 2.5?±?1.4 years) constituted the final study population. Thirty-nine scans were performed at 3 T and 21 scans were performed at 1.5 T. Two different reviewers independently and blindly qualitatively evaluated all sequences to determine image quality and extent of artifacts.

Results

MP-GRE and radial 3-D-GRE sequences had the least respiratory motion (P?Conclusions Our preliminary results support the preference of fat-suppressed radial 3-D-GRE as the best post-contrast T1-weighted imaging approach for patients under the age of 5 years, when dynamic imaging is not essential.     

MR imaging of the neonatal brain at 3 Tesla

3 Telsa MR scanners are now becoming more widely available and 3 Telsa is likely to become the filed strength of choice for clinical imaging of the brain. The neonatal brain can be safely and successfully imaged at 3 Telsa. The improved signal to noise afforded by a higher field strength may be used to improve image quality or shorten acquisition times. This may be exploited for conventional T1 and T2 weighted imaging and also for advanced techniques such as diffusion tensor imaging, angiography and functional magnetic resonance studies.     

Benefits and unexpected artifacts of biplanar digital slot-scanning imaging in children

Biplanar digital slot-scanning allows for relatively low-dose orthopedic imaging, an advantage in imaging children given the growing concerns regarding radiosensitivity. We have used this system for approximately 1 year for orthopedic imaging of the spine and lower extremities. We have noted advantages of using the digital slot-scanning system when compared with computed radiographic and standard digital radiographic imaging systems, but we also found unexpected but common imaging artifacts that are the direct result of the imaging method and that have not been reported. This pictorial essay serves to familiarize radiologists with the advantages of the digital slot-scanning system as well as imaging artifacts common with this new technology.     

Pediatric neuroimaging using magnetic resonance imaging during non-sedated sleep

Background

Etiological studies of many neurological and psychiatric disorders are increasingly turning toward longitudinal investigations of infant brain development in order to discern predisposing structural and/or functional differences prior to the onset of overt clinical symptoms. While MRI provides a noninvasive window into the developing brain, MRI of infants and toddlers is challenging due to the modality’s extreme motion sensitivity and children’s difficulty in remaining still during image acquisition.

Objective

Here, we outline a broad research protocol for successful MRI of children under 4 years of age during natural, non-sedated sleep.

Materials and methods

All children were imaged during natural, non-sedated sleep. Active and passive measures to reduce acoustic noise were implemented to reduce the likelihood of the children waking up during acquisition. Foam cushions and vacuum immobilizers were used to limit intra-scan motion artifacts.

Results

More than 380 MRI datasets have been successfully acquired from 220 children younger than 4 years of age within the past 39 months. Implemented measures permitted children to remain asleep for the duration of the scan and allowed the data to be acquired with an overall 97% success rate.

Conclusion

The proposed method greatly advances current pediatric imaging techniques and may be readily implemented in other research and clinical settings to facilitate and further improve pediatric neuroimaging.     

Three‐dimensional models of the segmented human fetal brain generated by magnetic resonance imaging

Recent advances in imaging technology have enabled us to obtain more detailed images of the human fetus in a nondestructive and noninvasive manner. Through detailed images, elaborate three‐dimensional (3D) models of the developing brain can be reconstructed. The segmentation of the developing brain has been determined by serial sections. Therefore, in this study, we attempted to develop a 3D model of the fetal brain using magnetic resonance image (MRI). MR images from 19 specimens (11 embryonic specimens and eight fetal specimens from 5.2 to 225 mm in crown rump length) were used to reconstruct 3D models of regionalized developing brains. From this analysis, we succeeded in registering a maximum of nine landmarks on MR images and reconstructing 19 sequential models of the regionalized developing brain. To confirm the validity of the landmarks, we also compared our results with three serial sections from the Kyoto Collection; the same morphological characteristics were observed on both serial sections and MRI. The morphological minutiae could be found on MR images, and regionalized models of the developing brain could be reconstructed. These results will be useful for clinical diagnosis of living fetuses in utero.     

Fast,free-breathing and motion-minimized techniques for pediatric body magnetic resonance imaging

Magnetic resonance imaging (MRI) is the preferred imaging modality in children with complex medical issues. Patient motion and respiration remain major challenges in pediatric abdominal MRI. Young children ages 3 months to 6 years are unable to cooperate or perform breath-holding and frequently require deep sedation or general anesthesia to undergo MRI. Given the growing concerns associated with the use of sedation and anesthesia as well as the adverse impact on workflow, developing and implementing fast and motion-resistant MRI sequences are of great interest. Fast sequences such as single-shot fast spin echo and balanced steady-state free precession are useful as quick anatomical surveys on routine abdominal MRI. The widespread utilization of parallel imaging and sequences with radial k-space sampling has contributed to decreasing scan time and improving image quality, respectively. Newer strategies including compressed sensing, simultaneous multi-slice acquisition, and hybrid approaches hold the prospect of faster image acquisition that could significantly reduce the need for sedation in this vulnerable population and decrease the time of anesthesia in cases where it is indicated.     

Safety of Magnetic Resonance Imaging After Implantation of Stainless Steel Embolization Coils

Stainless steel embolization coils (SSEC) have been used for over four decades for vascular occlusion. Recently, the safety of these coils in a magnetic resonance environment has been called into question, with important ramifications for thousands of patients with existing coils in place. We performed a retrospective chart review at five tertiary care pediatric centers evaluating all children and young adults with implanted SSEC who underwent magnetic resonance imaging (MRI). Data reviewed included demographics, coil implantation, MRI studies, and follow-up evaluations. Complications such as heating, discomfort, or device migration were specifically sought. Two hundred and ninety-seven patients with implanted SSEC underwent 539 MRI examinations. The median age at SSEC implantation was 2.3 years (1 week–23.2 years). The MRI studies were performed a median of 7.4 years (4 days–23.1 years) after implantation. No patients experienced any reported complications associated with their MRI examinations during the study or at median follow-up post-MRI of 4.8 years (1 day–23 years). In this large, retrospective review of patients with implanted SSEC undergoing MRI, there were no reported adverse events. These findings support the recent change by Cook Medical Inc. of their standard embolization coils from a designation of magnetic resonance unsafe to conditional.     

Role of diffusion-weighted imaging in differentiating benign and malignant pediatric abdominal tumors

Background

Solid malignant tumors are more highly cellular than benign lesions and hence have a restricted diffusion of water molecules.

Objective

To evaluate whether diffusion-weighted MR imaging (DWI) can differentiate between benign and malignant pediatric abdominal tumors.

Materials and methods

We retrospectively analyzed DWI scans of 68 consecutive children with 39 benign and 34 malignant abdominal masses. To calculate the apparent diffusion coefficient (ADC) maps and ADC values, we used 1.5-T sequences at TR/TE/b-value of 5,250–7,500/54–64/b?=?0, 500 and 3-T sequences at 3,500–4,000/66–73/b?=?0, 500, 800. ADC values were compared between benign and malignant and between data derived at 1.5 tesla (T) and at 3 tesla magnetic field strength, using the Mann-Whitney-Wilcoxon test, ANOVA and a receiver operating curve (ROC) analysis.

Results

There was no significant difference in ADC values obtained at 1.5 T and 3 T (P?=?0.962). Mean ADC values (× 10^?3?mm²/s) were 1.07 for solid malignant tumors, 1.6 for solid benign tumors, 2.9 for necrotic portions of malignant tumors and 3.1 for cystic benign lesions. The differences between malignant and benign solid tumors were statistically significant (P?=?0.000025). ROC analysis revealed an optimal cut-off ADC value for differentiating malignant and benign solid tumors as 1.29 with excellent inter-observer reliability (alpha score 0.88).

Conclusion

DWI scans and ADC values can contribute to distinguishing between benign and malignant pediatric abdominal tumors.     

Blood Pool Segmentation Results in Superior Virtual Cardiac Models than Myocardial Segmentation for 3D Printing

The method of cardiac magnetic resonance (CMR) three-dimensional (3D) image acquisition and post-processing which should be used to create optimal virtual models for 3D printing has not been studied systematically. Patients (n = 19) who had undergone CMR including both 3D balanced steady-state free precession (bSSFP) imaging and contrast-enhanced magnetic resonance angiography (MRA) were retrospectively identified. Post-processing for the creation of virtual 3D models involved using both myocardial (MS) and blood pool (BP) segmentation, resulting in four groups: Group 1—bSSFP/MS, Group 2—bSSFP/BP, Group 3—MRA/MS and Group 4—MRA/BP. The models created were assessed by two raters for overall quality (1—poor; 2—good; 3—excellent) and ability to identify predefined vessels (1–5: superior vena cava, inferior vena cava, main pulmonary artery, ascending aorta and at least one pulmonary vein). A total of 76 virtual models were created from 19 patient CMR datasets. The mean overall quality scores for Raters 1/2 were 1.63 ± 0.50/1.26 ± 0.45 for Group 1, 2.12 ± 0.50/2.26 ± 0.73 for Group 2, 1.74 ± 0.56/1.53 ± 0.61 for Group 3 and 2.26 ± 0.65/2.68 ± 0.48 for Group 4. The numbers of identified vessels for Raters 1/2 were 4.11 ± 1.32/4.05 ± 1.31 for Group 1, 4.90 ± 0.46/4.95 ± 0.23 for Group 2, 4.32 ± 1.00/4.47 ± 0.84 for Group 3 and 4.74 ± 0.56/4.63 ± 0.49 for Group 4. Models created using BP segmentation (Groups 2 and 4) received significantly higher ratings than those created using MS for both overall quality and number of vessels visualized (p < 0.05), regardless of the acquisition technique. There were no significant differences between Groups 1 and 3. The ratings for Raters 1 and 2 had good correlation for overall quality (ICC = 0.63) and excellent correlation for the total number of vessels visualized (ICC = 0.77). The intra-rater reliability was good for Rater A (ICC = 0.65). Three models were successfully printed on desktop 3D printers with good quality and accurate representation of the virtual 3D models. We recommend using BP segmentation with either MRA or bSSFP source datasets to create virtual 3D models for 3D printing. Desktop 3D printers can offer good quality printed models with accurate representation of anatomic detail.     

Characterization of acoustic noise in a neonatal intensive care unit MRI system

Background

To eliminate the medical risks and logistical challenges of transporting infants from the neonatal intensive care unit (NICU) to the radiology department for magnetic resonance imaging, a small-footprint 1.5-T MRI scanner has been developed for neonatal imaging within the NICU. MRI is known to be noisy, and exposure to excessive acoustic noise has the potential to elicit physiological distress and impact development in the term and preterm infant.

Objective

To measure and compare the acoustic noise properties of the NICU MRI system against those of a conventional 1.5-T MRI system.

Materials and methods

We performed sound pressure level measurements in the NICU MRI scanner and in a conventional adult-size whole-body 1.5-T MRI system. Sound pressure level measurements were made for six standard clinical MR imaging protocols.

Results

The average sound pressure level value, reported in unweighted (dB) and A-weighted (dBA) decibels for all six imaging pulse sequences, was 73.8 dB and 88 dBA for the NICU scanner, and 87 dB and 98.4 dBA for the conventional MRI scanner. The sound pressure level values measured on the NICU scanner for each of the six MR imaging pulse sequences were consistently and significantly (P?=?0.03) lower, with an average difference of 14.2 dB (range 10–21 dB) and 11 dBA (range 5–18 dBA). The sound pressure level frequency response of the two MR systems showed a similar harmonic structure above 200 Hz for all imaging sequences. The amplitude, however, was appreciably lower for the NICU scanner, by as much as 30 dB, for frequencies below 200 Hz.

Conclusion

The NICU MRI system is quieter than conventional MRI scanners, improving safety for the neonate and facilitating siting of the unit within the NICU.     

CAIPIRINHA-accelerated T1w 3D-FLASH for small-bowel MR imaging in pediatric patients with Crohn’s disease: assessment of image quality and diagnostic performance

Background

The “Controlled Aliasing In Parallel Imaging Results In Higher Acceleration” (CAPIRINHA) technique greatly accelerates T1w 3D fast low angle shot (FLASH) scans while maintaining high image quality. We studied image quality and conspicuity of inflammatory lesions on CAIPIRINHA-accelerated imaging for pediatric small-bowel magnetic resonance imaging (MRI).

Methods

Forty-four consecutive patients (mean 14±3 years, 18 girls) underwent small-bowel MRI (MR enterography, MRE) at 1.5 T including diffusion-weighted imaging (DWI), contrast-enhanced CAIPIRINHA 3D-FLASH and standard 2D-FLASH imaging. Crohn’s disease (CD) was confirmed in 26 patients, 18 patients served as control. Independent blinded readings were performed for grading of image quality and conspicuity of CD lesions on CAIPIRINHA FLASH and standard FLASH images in comparison to a reference standard comprising imaging and endoscopic data.

Results

CAIPIRINHA FLASH yielded significantly higher image quality with good inter-observer agreement (κ=0.68) and showed better visual delineation in 40% of the assessed bowel lesions, as compared to standard FLASH. There was full agreement for identification of CD patients between CAIPIRINHA and standard FLASH. CAIPIRINHA FLASH detected two small-bowel lesions that were not seen on standard FLASH. DWI revealed additional inflammatory lesions inconspicuous on contrast-enhanced imaging. MRE showed an overall diagnostic accuracy of 93%.

Conclusion

We present first evidence that CAIPIRINHA greatly accelerates T1w imaging in paediatric MRE without trade-off in image quality or lesion conspicuity and is thus preferable to standard FLASH imaging.

     

Application of a three-point method for water-fat MR imaging in children

Background. Effective fat suppression is desirable in clinical magnetic resonance imaging. Conventional frequency selective fat suppression is dependent on accurate prescan shimming and is subject to artifacts due to magnetic field inhomogeneity. Quadrature three-point water-fat imaging with direct phase encoding is an alternative technique for fat suppression that has been previously described in adult volunteers and patients. Objective. To evaluate the use of three-point water-fat imaging with direct phase encoding for fat-suppressed MR scans in children. Materials and methods. Sixty-two three-point water-fat imaging studies were performed in 55 children 2 months to 18 years old. T 1-weighted fat-suppressed (water) images from this sequence were compared with frequency selective fat-suppressed images obtained in 15 patients. The reliability and subjective quality of the sequence were assessed in the remaining 47 cases. Results. High-quality fat suppression was achieved in all anatomic sites studied, even where frequency selective fat-suppression failed due to magnetic susceptibility artifact. The three-point water-fat sequence was visually preferred to the frequency selective fat saturation technique in 15/15 cases. Conclusion. Three-point water-fat imaging has replaced the conventional frequency selective technique for fat suppression on T 1-weighted MR imaging at our institution. Received: 27 July 1998 Accepted: 23 December 1998     

Infant Cardiac Magnetic Resonance Imaging Using Oscillatory Ventilation: Safe and Effective

Cardiac magnetic resonance imaging (CMR) for infants and young children typically requires sedation. General anesthesia with controlled ventilation can eliminate motion artifact with breath-holds during imaging to limit respiratory artifact, but these may lead to atelectasis or other complications. High-frequency oscillatory ventilation (HFOV) provides ventilation with near-constant mean airway pressure and minimal movement of chest wall and diaphragm, thus obviating the need for breath-holding. Clinical data were collected for 8 infants who underwent CMR with HFOV and 8 controls who underwent CMR with conventional ventilator and breath-hold technique. Data included demographic information, adverse events, and scan-acquisition time. Studies were reviewed for image quality by two cardiologists who were blinded to type of ventilation. There were no significant differences in patient characteristics between the two groups. There was no significant difference in average image quality for cine short-axis or black blood imaging. Total CMR scan time was not significantly different between groups, but the short-axis cine stack was acquired more quickly in the HFOV group (1.8 ± 0.8 vs. 5.0 ± 3.6 min). There were no adverse events in the HFOV group, but scans were terminated early for two patients in the conventional ventilator group. HFOV during CMR is feasible and well tolerated. Image quality is equivalent to that obtained with conventional ventilation with breath-holding technique and allows shorter cine scan times for some sequences.     

Vitamin D at the onset of type 1 diabetes in Italian children

Low vitamin D levels have been reported in multiple immune disorders such as type 1 diabetes mellitus (T1DM). The purpose of our study was to determine vitamin D levels in children at the onset of T1DM compared with children with other diseases and to test the hypothesis that low vitamin D may increase the odds for developing diabetes. All the children (n?=?58) that were consecutively admitted to our clinic at T1DM onset between May 2010 and July 2012 were compared with a control group of children (n?=?166) hospitalized for other diseases, matched for sex, season of visit, and age. For each subject, we considered clinical and anthropometric data, the season at time of hospitalization, and serum 25-hydroxyvitamin D (25(OH)D), which were analyzed and compared using multivariable conditional logistic regression. Median 25(OH)D was significantly lower in the diabetic patients (36.2 nmol/l, range?=?7.5–121.0 nmol/l) than in controls (48.7 nmol/l, range?=?7.5–190.2 nmol/l), p?=?0.010. Low 25(OH)D levels seem to increase the odds for developing T1DM (odds ratio (OR)?=?3.45 for 25(OH)D 51–74 nmol/l, OR?=?5.56 for 25(OH)D?≤?50 nmol/l). There was no seasonal effect on the risk of developing T1DM. Median 25(OH)D level was significantly lower in patients admitted with diabetic ketoacidosis (30.2 nmol/l, range?=?7.5–101.8 nmol/l) than in patients without ketoacidosis (40.7 nmol/l, range?=?15.2–121.1 nmol/l), p?=?0.019; but when adjusted for season, the p value was 0.116. Conclusions: Children at onset of T1DM have lower vitamin D serum levels than those with other diseases. Further longitudinal studies on children before the onset of T1DM will allow clinicians to explore the causal relationship between vitamin D and T1DM.     

Age-related apparent diffusion coefficients of lumbar vertebrae in healthy children at 1.5 T

Background

Diffusion-weighted magnetic resonance imaging with apparent diffusion coefficient (ADC) calculation is important for detecting bone marrow pathologies.

Objective

To investigate age-related differences of lumbar vertebral body ADC to establish normal values for healthy children.

Materials and methods

Forty-nine healthy children without any history of oncological or hematological diseases (10.2±4.7 years, range: 0–20 years) were included in this retrospective study. All magnetic resonance imaging (MRI) examinations were performed at 1.5 T and with similar scan parameters. The diffusion-weighted sequences were performed with b values of 50, 400 and 800 s/mm². ADC values were measured by placing regions of interest at three different levels within each lumbar vertebral body (L1 to L5). ADC values were analyzed for different age groups (0–2 years, 3–6 years, 7–11 years, 12–14 years, 15–20 years), for each vertebral and intravertebral level.

Results

The mean ADC of the whole study group was 0.60±0.09?×?10^?3 mm²/s. Children between the ages of 12 and 14 years had significantly higher ADC compared to the other age groups (P≤0.0003). ADC values were significantly higher in the 1st lumbar vertebral body compared to the other levels of the lumbar spine (P<0.005) with the exception of L5, and in the upper third of the vertebral bodies compared to the middle or lower thirds (P≤0.003).

Conclusion

The age-, vertebral- and intravertebral level-dependent differences in ADC suggest a varying composition and cellularity in different age groups and in different locations.

     

Image Quality of Coronary Computed Tomography Angiography with 320-Row Area Detector Computed Tomography in Children with Congenital Heart Disease

The objective of this study was to assess factors affecting image quality of 320-row computed tomography angiography (CTA) of coronary arteries in children with congenital heart disease (CHD). We retrospectively reviewed 28 children up to 3 years of age with CHD who underwent prospective electrocardiography (ECG)-gated 320-row CTA with iterative reconstruction. We assessed image quality of proximal coronary artery segments using a five-point scale. Age, body weight, average heart rate, and heart rate variability were recorded and compared between two groups: patients with good diagnostic image quality in all four coronary artery segments and patients with at least one coronary artery segment with nondiagnostic image quality. Altogether, 96 of 112 segments (85.7 %) had diagnostic-quality images. Patients with nondiagnostic segments were significantly younger (10.0 ± 11.6 months) and had lower body weight (5.9 ± 2.9 kg) (each p < 0.05) than patients with diagnostic image quality of all four segments (20.6 ± 13.8 months and 8.4 ± 2.5 kg, respectively; each p < 0.05). Differences in heart rate and heart rate variability between the two imaging groups were not significant. Receiver operating characteristic analyses for predicting patients with nondiagnostic image quality revealed an optimal body weight cutoff of ≤5.6 kg and an optimal age cutoff of ≤12.5 months. Prospective ECG-gated 320-row CTA with iterative reconstruction provided feasible image quality of coronary arteries in children with CHD. Younger age and lower body weight were factors that led to poorer image quality of coronary arteries.     

Navigated abdominal T1-W MRI permits free-breathing image acquisition with less motion artifact

T1-W imaging of the pediatric abdomen is often limited by respiratory motion artifacts. Although navigation has been commonly employed for coronary MRA and T2-W imaging, navigation for T1-W imaging is less developed. Thus, we incorporated a navigator pulse into a fat-suppressed T1-W SPGR sequence such that steady-state contrast was not disrupted. Ten children were scanned after gadolinium administration three times in immediate succession: breath-hold with no navigation, free-breathing with navigation, and free-breathing without navigation. Motion artifacts were scored for each sequence by two radiologists, showing fewer motion artifacts with navigation compared to free-breathing and greater motion artifacts than with breath-holding. This work demonstrates the feasibility and potential utility of navigation for pediatric abdominal T1-W imaging.     

Spinal ultrasound in patients with anorectal malformations: is this the end of an era?

Purpose

Even if lumbar magnetic resonance imaging (MRI) is considered the gold standard in the diagnosis of occult spinal dysraphism (SD) in patients with anorectal malformations (ARMs), spinal ultrasound (US) performed up to 5 months of life have been largely used as a screening test. The aim of the present study was to evaluate the accuracy in terms of sensibility and specificity of neonatal US to detect occult SD in patients with ARMs.

Methods

Retrospective analysis of all patients treated for ARMs between 1999 and 2013 at our institution who underwent both spinal US (up to 5 months of life) and MRI. Sensibility and specificity have been calculated for US based on MRI results.

Results

Of 244 patients treated for ARMs at our institution, 82 (34 females, 48 males) underwent both the imaging studies and have been included in this study. ARMs types were: anal stenosis (7), recto-vestibular fistula (19), recto-perineal fistula (3) and cloaca (5) in female and imperforate anus (7) recto-perineal fistula (14), recto-urethral fistula (22), recto-vesical fistula (5) in males. Forty-seven patients (57, 3 % of total, 18 females, 29 males) had some occult SD (tethered spinal cord, spinal lipoma, syringomyelia) at MRI. Only 7 (14, 8 %) patients of those with spinal anomalies at MRI had pathological US studies. In our population, sensibility and specificity of US for diagnosis of occult SD were, respectively, 14, 8 and 100 %.

Conclusion

Since it is well known that a screening test must have a high sensibility, our data suggest that spinal ultrasound is not suitable as a screening test for occult spinal dysraphism in patients with ARMs. Furthermore, we strongly advise against the use of US as a screening test for spinal dysraphism to prevent a false sense of security in physician and patients’ families.     

Fetal MRI: obstetrical and neurological perspectives

Despite major advances in the understanding and in the genetics of several diseases of the developing brain, early prediction of the neurological prognosis of brain abnormality discovered in utero or of white matter damage discovered in a preterm neonate remains particularly difficult. Advances in prenatal diagnosis and the increased rate of survival of extremely preterm infants who are at higher risk of developing white matter damage underline the critical and urgent need for reliable predictive techniques. New imaging techniques such as diffusion-weighted imaging, magnetic resonance spectroscopy or functional MRI applied to the fetus represent promising tools in this perspective.     

Increased Regional Deformation of the Left Ventricle in Normal Children With Increased Body Mass Index: Implications for Future Cardiovascular Health

The prevalence of obesity continues to increase in the developing world. The effects of obesity on the cardiovascular system include changes in systolic and diastolic function. More recently obesity has been linked with impairment of longitudinal myocardial deformation properties in children. We sought to determine the effect of increased body mass index (BMI) on cardiac deformation in a group of children taking part in the population-based Southampton Women’s Survey to detect early cardiovascular changes associated with increasing BMI before established obesity. Sixty-eight children at a mean age of 9.4 years old underwent assessment of longitudinal myocardial deformation in the basal septal segment of the left ventricle (LV) using two-dimensional speckle tracking echocardiography. Parameters of afterload and preload, which may influence deformation, were determined from cardiac magnetic resonance imaging. BMI was determined from the child’s height and weight at the time of echocardiogram. Greater pediatric BMI was associated with greater longitudinal myocardial deformation or strain in the basal septal segment of the LV (β = 1.6, p < 0.001); however, this was not related to contractility or strain rate in this part of the heart (β = 0.001, p = 0.92). The end-diastolic volume of the LV increased with increasing BMI (β = 3.93, p < 0.01). In young children, regional deformation in the LV increases with increasing BMI, whilst normal contractility is maintained. This effect may be explained by the increased preload of the LV associated with increased somatic growth. The long-term implications of this altered physiology need to be followed-up.