Project Abstract Motivation: This is a successor application of our successful project, Rapid Robust Pediatric MRI, R01 EB009690. MRI offers superb soft tissue contrast for children, without the ionizing radiation and cancer risk of CT. However, MRI use has been limited due to long exams, low spatial resolution, and motion-artifacts. Thus, MRI often requires prolonged anesthesia with breath-holds and attendant risk; hence, children often are denied the benefits of cross-sectional imaging altogether or are exposed to ionizing radiation. The previous project addressed these concerns by creating a dedicated pediatric imaging system. Highly parallel, high-SNR 3T receive coil arrays were developed specifically for pediatric body imaging. The high SNR was used to accelerate scans reconstructed with parallel imaging, new motion correction algorithms, Compressed Sensing (CS), and higher-dimensional non-Cartesian scanning. This system is now being used extensively in clinical practice, significantly reducing anesthesia depth and duration, and has markedly increased our MRI utilization. Key technologies have been or are now being commercialized with GE Healthcare, including the pediatric receive array, CS, dynamic contrast enhancement, 4D flow, full-Fourier single-shot T2-weighted scanning, coil compres- sion, and Deep Learning (DL) based image reconstruction. Siemens has licensed 21 of our patents, implemented some of them in work-in-progress packages, and productized our coil compression and our ESPIRiT coil sensi- tivity estimation. Philips has licensed six of our patents. This ensures broad impact. Despite this significant progress a substantial number of exams still require anesthesia due to patient discomfort. This proposal focuses on one such common study, diagnosing Inflammatory Bowel Disease (IBD). Current MRI techniques require glucagon to stop bowel motion, and this produces pain, nausea, and vomiting. Intravenous gadolinium contrast is also required. Our goal in this project is to develop advanced MRI techniques which obviate the need for glucagon and IV gadolinium. This will allow more patients to be studied, eliminate anesthesia, and dramatically improve their MRI experience. The developed core technologies will impact other MRI exams as well. Approach: The project has three development aims, validated by a fourth aim of clinical studies. Aim 1 will enable fast dynamic 2D imaging at higher spatial and temporal resolutions. Aim 2 will develop free-breathing 3D contrast-enhanced imaging that can resolve moving bowel, eliminating the need for intravenous glucagon. Aim 3 will enable high resolution motion-robust non-contrast characterization of the bowel wall, eliminating the need for intravenous gadolinium. The impact of all of these developments will be assessed in children with IBD. Significance: This work will lead to fast, robust, broadly-applicable pediatric MRI protocols with less anesthe- sia, making MRI safer, cheaper, and more available to children. MRI will be transformed into a workhorse modality for IBD, improving their care and reducing CT radiation burden. The techniques will also facilitate wide application of MRI to new applications, for both pediatric and adult diseases.

Project Narrative After our considerable progress in reducing the need for anesthesia during pediatric MRI scans, this work aims to further reduce anesthesia through faster imaging, greater motion-robust acquisition and reconstruction tech- niques, and less need for intravenous access. Developments will focus on the clinical testbed of MRI for Inflam- matory Bowel Disease, a particularly challenging exam for children. This will make MRI safer, cheaper, and more widely available to children, reducing the population risk of radiation from CT.