Rationale and Objectives
During a magnetic resonance imaging (MRI) examination, patients are required to remain still to minimize motion that may compromise image quality and may make rescanning necessary. It is often assumed that anxiety, which is experienced by a considerable number of patients undergoing an MR examination, increases motion and decreases image quality. The present study explores the relationship between anxiety and movement of patients during an MR examination.
Materials and Methods
Anxiety was measured subjectively by means of the State Anxiety Inventory and a visual analogue scale for claustrophobia. Motion and image quality were measured in three different ways. First, software was used that allows an estimation of motion based on tracker scans between the clinical scans. Second, the MRI technician who performed the MR examination was asked to indicate the degree of motion artifacts and image quality for each patient. Third, after all scans had been collected, two radiologists evaluated each clinical scan.
Results
No or low correlations between anxiety and the distinct measures of motion and image quality were found for all three measures.
Conclusions
This finding shows that there is little evidence for the assumption that anxiety increases motion and decreases image quality during an MR examination.
Magnetic resonance imaging (MRI) is an important and widely used diagnostic tool in clinical practice. Unfortunately, MR examinations are associated with anxiety reactions in many patients. Studies have consistently shown that more than one third of patients undergoing an MR examination experience anxiety and that approximately 15% of patients require sedation to be able to tolerate the examination . Besides concerns about the diagnosis, causes of anxiety include the length of the procedure and the loud noise of the scanner . In addition, anxiety may be because of the narrowness of the bore and associated movement restrictions . Having to remain still is often reported as the most unpleasant aspect of an MR examination .
Remaining still during an MR examination is necessary because body movement can reduce image quality and may consequently decrease diagnostic utility. In addition, degraded image quality may make it necessary to repeat a scan which increases examination time and consumes expensive resources. It has been reported that motion artifacts that impair diagnostic quality occur in up to 7% of all MR examinations .
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Material and methods
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Subjects
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Measures
Anxiety
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Motion Artifacts and Image Quality
Motion Tracker
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Evaluation by MRI Technicians
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Evaluation by Radiologists
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Procedure
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Data Analysis
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Results
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Table 1
Anxiety Scores and Demographic Information
Anxiety Scores, Anxiolytics and Age Total Women (N = 23) Men (N = 16) Anxiolytics No (N = 26) Yes (N = 13) Pre-STAIs 55.5 (SD = 13.8) 56.1 (SD = 12.7) 54.5 (SD = 15.7) 54.7 (SD = 14.1) 56.9 (SD = 13.7) Claustrophobia 73 (SD = 20.4) 73.4 (SD = 21.4) 72.3 (SD = 19.6) 70.1 (SD = 22.5) 78.5 (SD = 14.7) Post-STAIs 42.5 (SD = 16.5) 42.3 (SD = 15) 42.8 (SD = 19) 44.1 (SD = 17.7) 39.2 (SD = 14) STAIt 42.5 (SD = 12) 42.1 (SD = 9.9) 43.2 (SD = 14.8) 42.6 (SD = 13.2) 42.3 (SD = 9.4) Anxiolytics No (%) 26 (66.7) 15 (65.2) 11 (68.8) Yes (%) 13 (33.3) 8 (34.8) 5 (31.3) Age, y 53 (SD = 12) 51 (SD = 10) 54 (SD = 15) 53 (SD = 11) 52 (SD = 14)
SD, standard deviation; STAIs, state anxiety; STAIt, trait anxiety.
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Table 2
Correlations Between Distinct Measures for Movement and/or Motion Artifacts and Image Quality
Movement, Motion Artifacts and Image Quality MRI Technicians Radiologists Movement Image Quality Motion Artifacts Image Quality Radiologist 1 Radiologist 2 Radiologist 1 Radiologist 2 Motion tracker Translation 0.38* 0.35* 0.51** Rotation 0.34* 0.29 0.39* MRI technicians Movement 0.55** 0.67** Image quality 0.42** 0.42**
MRI, magnetic resonance imaging.
*Significant at P < .05; **significant at P < .001.
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Motion Tracker
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Table 3
Correlations Between Anxiety and Movement as Measured by the Motion Tracker
Movement pre-STAIs Claustrophobia Motion tracker Translation 0.15 −0.13 Rotation −0.07 −0.4*
STAIs, state anxiety.
*Significant at P < .05.
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Evaluation by MRI Technicians
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Table 4
Correlations Between Anxiety and Movement and Image Quality as Evaluated by MRI Technicians
Movement and Image Quality pre-STAIs Claustrophobia Movement 0.22 0.19 Image quality −0.27 −0.26
MRI, magnetic resonance imaging.
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Evaluation by Radiologists
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Table 5
Image Quality and Motion Artifacts for all Clinical Scans
Image Quality Radiologist 1 (N = 185), n (%) Radiologist 2 (N = 180), n (%) Motion Artifacts (Caused by Patient Movement) Radiologist 1 (N = 185), n (%) Radiologist 2 (N = 180), n (%) Very poor 2 (1.1) Many motion artifacts 1 (0.5) 19 (10.6) Poor 3 (1.6) 28 (15.6) Some motion artifacts 17 (9.2) 41 (22.8) Reasonable 21 (11.4) 117 (65) Very few motion artifacts 19 (10.3) 55 (30.6) Good 153 (82.7) 33 (18.3) No motion artifacts 148 (80) 65 (36.1) Very good 8 (4.3) Mean (median) overall image quality 3.9 (4) 3 (3)
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Table 6
Correlations Between Anxiety and Motion Artifacts and Image Quality as Evaluated by Radiologists
Motion Artifacts and Image Quality Pre-STAIs Claustrophobia Motion artifacts Radiologist 1 0.03 0.11 Radiologist 2 0.22 −0.04 Image quality Radiologist 1 0.0 −0.06 Radiologist 2 −0.34* −0.13
STAIs, state anxiety.
*Significant at P < .05.
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Discussion and conclusions
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Acknowledgments
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References
1. Brennan S.C., Redd W.H., Jacobsen P.B., et. al.: Anxiety and panic during magnetic resonance scans. Lancet 1988; 2: pp. 512.
2. Katz R.C., Wilson L., Frazer N.: Anxiety and its determinants in patients undergoing magnetic resonance imaging. J Behav Ther Exp Psychiatry 1994; 25: pp. 131-134.
3. Murphy K.J., Brunberg J.A.: Adult claustrophobia, anxiety and sedation in MRI. Magn Reson Imaging 1997; 15: pp. 51-54.
4. Van Minde D., Klaming L., Weda H.: Pinpointing moments of high anxiety during an MRI examination. Int J Behav Med 2014; 21: pp. 487-495.
5. Dewey M., Schink T., Dewey C.F.: Claustrophobia during magnetic resonance imaging: cohort study in over 55,000 patients. J Magn Reson Imaging 2007; 26: pp. 1322-1327.
6. McIsaac H.K., Thordarson D.S., Shafran R., et. al.: Claustrophobia and the magnetic resonance imaging procedure. J Behav Med 1998; 21: pp. 255-268.
7. Melendez J.C., McCrank E.: Anxiety-related reactions associated with magnetic resonance imaging examinations. JAMA 1993; 270: pp. 745-747.
8. Quirk M.E., Letendre A.J., Ciottone R.A., et. al.: Anxiety in patients undergoing MR imaging. Radiology 1989; 170: pp. 463-466.
9. Dantendorfer K., Amering M., Bankier A., et. al.: A study of the effects of patient anxiety, perceptions and equipment on motion artifacts in magnetic resonance imaging. Magn Reson Imaging 1997; 15: pp. 301-306.
10. Forbes K.P., Pipe J.G., Bird C.R., et. al.: Propeller MRI: clinical testing of a novel technique for quantification and compensation of head motion. J Mag Reson Imaging 2001; 14: pp. 215-222.
11. Törnqvist E., Mansson A., Larsson E.M., et. al.: Impact of extended written information on patient anxiety and image motion artifacts during magnetic resonance imaging. Acta Radiol 2006; 5: pp. 474-480.
12. Grey S.J., Price G., Mathews A.: Reduction of anxiety during MR imaging: a controlled trial. Magn Reson Imaging 2000; 18: pp. 351-355.
13. Hollenhorst J., Munte S., Friedrick L., et. al.: Using intranasal midazolam spray to prevent claustrophobia induced by MR imaging. AJR 2001; 176: pp. 865-868.
14. Cooke A., Kavussanu M., McIntyre D., et. al.: Psychological, muscular and kinematic factors mediate performance under pressure. Psychophysiology 2010; 47: pp. 1109-1118.
15. Joormann J., Stober J.: Somatic symptoms of generalized anxiety disorder for the DSM-IV: associations with pathological worry and depression symptoms in a nonclinical sample. J Anxiety Disord 1999; 13: pp. 491-503.
16. Pijpers J.R., Oudejans R.R.D., Bakker F.C.: Anxiety-induced changes in movement behaviour during the execution of a complex whole-body task. Q J Exp Psychology 2005; 58A: pp. 421-445.
17. Farha J.G., Sher K.J.: The effects of consent procedures on the psychophysiological assessment of anxiety: a methodological inquiry. Psychophysiology 1989; 26: pp. 185-191.
18. Eysenck M.W., Derakshan N., Santos R., et. al.: Anxiety and cognitive performance: attentional control theory. Emotion 2007; 7: pp. 336-353.
19. Gunnar M., Quevedo K.: The neurobiology of stress and development. Annu Rev Psychol 2007; 58: pp. 145-173.
20. Spielberger C.D.: State–Trait Anxiety Inventory.1983.Consulting Psychologists PressPalo Alto, CA
21. Spielberger C.D., Krasner S.S.: The assessment of state and trait anxiety.Noyes R.Roth M.Burrows G.D.Handbook of Anxiety.1988.Elsevier ScienceAmsterdam:pp. 31-51.
22. Van der Ploeg H.M.: De Zelf-Beoordelings Vragenlijst (STAI-DY). Tijdschrift voor Psychiatrie 1982; 24: pp. 576-588.
23. Van der Ploeg H.M.: Handleiding bij de zelf-beoordelings vragenlijst STAI-DY.2000.PearsonAmsterdam
24. Van Knippenberg F.C.E., Duivenvoorden H.J., Bonke B., et. al.: Shortening the State-Trait Anxiety Inventory. J Clin Epidemiol 1990; 43: pp. 995-1000.
25. MacKenzie R., Sims C., Owens R.G., et. al.: Patients’ perceptions of magnetic resonance imaging. Clin Radiol 1995; 50: pp. 137-143.
26. Nielsen T., Börnert P., Sénégas J.: Fast Inter-Scan Motion Detection and Compensation.2012.Proceedings of the International Society for Magnetic Resonance in Medicine, 20th Annual Meeting ProceedingsMelbourne, Australiapp. 2472.
27. Unser M., Aldroubi A., Gerfen C.R.: A multiresolution image registration procedure using spline pyramids. Proc SPIE 1993; pp. 160-170. 2034
28. Hemphill J.F.: Interpreting the magnitudes of correlation coefficients. Ame Psychol 2003; 58: pp. 78-80.
29. Pinel J.P.J.: Biopsychology.2000.Allyn & BaconNeedham Heights, MA
30. Azevedo T.M., Volchan E., Imbiriba L.A., et. al.: A freezing-like posture to pictures of mutilation. Psychophysiology 2005; 42: pp. 255-260.
31. Facchinetti L.D., Imbiriba L.A., Azevedo T.M., et. al.: Postural modulation induced by pictures depicting prosocial or dangerous contexts. Neurosci Lett 2006; 410: pp. 52-56.
32. Stins J.F., Roerdink M., Beek P.J.: To freeze or not to freeze? Affective and cognitive perturbations have markedly different effects on postural control. Hum Movement Sci 2010; 30: pp. 190-202.