https://doi.org/10.53453/ms.2026.4.11
Reduction of motion artifacts in MRI: anesthetic strategies
Justas Jurkevičius
1
, Aidas Jurkevičius
2
1
Lithuanian University of Health Sciences, Academy of Medicine, Faculty of Medicine, Kaunas, Lithuania
2
Lithuanian University of Health Sciences Kaunas Hospital, Department of Anesthesiology, Kaunas, Lithuania
Abstract
Introduction. Motion artifacts remain a major limitation of magnetic resonance imaging (MRI), often
compromising image quality and diagnostic accuracy. In patients unable to remain motionless, sedation and
anesthesia are frequently required, introducing additional challenges related to safety and airway management.
Aim. To analyze current evidence on anesthetic strategies for reducing motion artifacts in MRI, with a focus on
pharmacological agents, sedation depth, and airway management.
Methods. A narrative literature review was conducted using PubMed, Embase, the Cochrane Library, and Web
of Science databases from 2015 to March 2026. Studies evaluating anesthetic techniques for MRI, motion artifact
reduction, image quality, and safety outcomes were included.
Results. Propofol-based sedation provides the highest success rates for MRI completion, with rapid onset and
recovery, but is associated with dose-dependent respiratory depression and airway obstruction. Dexmedetomidine
preserves respiratory drive and offers a needle-free administration route but has slower onset and variable efficacy
when used alone. Combination therapy may optimize both efficacy and safety. Airway management plays a
critical role, as pharyngeal micromotion associated with airway obstruction can significantly degrade image
quality. Supraglottic airway devices may improve imaging outcomes while maintaining spontaneous ventilation.
Safety in the MRI environment requires specialized monitoring, equipment, and adherence to established
guidelines.
Conclusions. Effective reduction of motion artifacts in MRI requires an integrated approach combining
appropriate anesthetic technique, airway management, and patient-specific considerations. Propofol and
dexmedetomidine remain the primary pharmacological options, while optimization of airway management
represents an important and often underrecognized factor in improving image quality.
Keywords: magnetic resonance imaging, artifacts, anesthesia, propofol, dexmedetomidine.
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Medical Sciences 2026 Vol. 14 (2), p. 104-112, https://doi.org/10.53453/ms.2026.4.11
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1. Introduction
Magnetic resonance imaging (MRI) has become
a fundamental diagnostic tool in modern
medicine, providing superior soft tissue contrast
and multiplanar imaging without the use of
ionizing radiation. However, MRI's prolonged
acquisition times and sensitivity to motion make
it especially vulnerable to image degradation
from patient movement. These artifacts arise
from multiple sources, including voluntary
patient movement, involuntary physiological
motion (respiration, cardiac pulsation,
peristalsis), and subtle micromotion associated
with airway obstruction during sedation (1,2).
These artifacts appear as ghosting, blurring, and
signal loss that can compromise diagnostic
accuracy, necessitate repeat examinations, and
increase healthcare costs (3).
Despite advances in technical solutions such as
respiratory gating, parallel imaging, and motion
correction algorithms, patient motion remains an
ongoing challenge. This is particularly evident in
pediatric populations, patients with
developmental disabilities, those experiencing
pain or anxiety, and in imaging sequences
requiring prolonged acquisition times (4). In
these contexts, anesthetic intervention, ranging
from minimal sedation to general anesthesia,
provides a practical solution by ensuring patient
immobility during image acquisition.
The MRI environment also presents unique
challenges for anesthetic care. The strong static
magnetic field, radiofrequency emissions,
acoustic noise exceeding 100 decibels, limited
patient access, and constraints on monitoring
equipment create hazards distinct from
traditional operating rooms (5). In the MRI
setting, anesthetic technique must balance
several competing demands. These include
immobility, respiratory stability, rapid recovery,
and safety in a remote environment. Together,
these factors draw attention to the importance of
optimizing anesthetic strategies to minimize
motion artifacts and ensure diagnostic-quality
imaging.
To address these issues, this review analyzes the
current evidence on anesthetic strategies to
reduce motion artifacts in MRI. It evaluates the
efficacy and safety of sedation strategies, with
particular attention to pharmacological agents
and airway management, and highlights optimal
protocols for different patient populations.
2. Materials and Methods
2.1. Literature Search Strategy
A comprehensive literature search was
conducted using PubMed, Embase, the Cochrane
Library, and Web of Science databases from
2015 to March 2026. Search terms included
combinations of the following keywords:
"magnetic resonance imaging," "MRI," "motion
artifacts," "sedation," "anesthesia," "propofol,"
"dexmedetomidine," "sevoflurane," "pediatric,"
"airway management," and related terms.
Reference lists of included articles were
manually reviewed to identify additional
relevant studies.
2.2. Inclusion and Exclusion Criteria
Studies were included if they met the following
criteria: (1) evaluated anesthetic or sedative
techniques for MRI procedures, (2) assessed
motion artifacts or image quality as outcomes,
(3) reported safety outcomes related to
sedation/anesthesia in the MRI environment, or
(4) provided guidance on anesthetic
management in MRI settings. Both original
research (randomized controlled trials,
observational studies) and clinical practice
guidelines were included. Case reports with
fewer than five patients and non-English
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language articles without available translations
were excluded.
2.3. Data Extraction and Synthesis
Data were extracted on the following variables:
study design, patient populations, anesthetic
techniques, motion artifact assessment methods,
image quality outcomes, safety events, and
recovery parameters. Due to substantial
heterogeneity in study design and outcome
measures, a narrative synthesis was conducted
instead of a formal meta-analysis.
3. Results
3.1.Mechanisms of Motion Artifacts in MRI
Motion artifacts in MRI arise from the physics of
image acquisition. MRI images are constructed
by sampling k-space data over time, usually
requiring seconds to minutes for complete
acquisition (1). Any motion during this period
causes phase and frequency encoding errors that
appear as characteristic artifacts (2). Periodic
motion (cardiac or respiratory) produces discrete
ghost artifacts that are displaced along the phase-
encoding direction, whereas random motion
causes diffuse blurring and signal loss (2,4).
Understanding these mechanisms is essential, as
they underpin both technical and anesthetic
strategies aimed at minimizing motion-related
image degradation.
The severity of motion artifacts depends on
multiple factors: the timing of motion relative to
k-space sampling (central k-space motion is
most detrimental), the amplitude and frequency
of motion, the imaging sequence employed, and
the anatomic region being imaged (1,2). High-
resolution sequences with prolonged acquisition
times are particularly susceptible (4). Notably,
even subtle head micromotion of 1-2 mm, often
associated with pharyngeal muscle relaxation
and airway obstruction during sedation, can
significantly degrade image quality in
neuroimaging applications (6).
3.2. Levels of Sedation and Anesthesia
The American Society of Anesthesiologists
defines a continuum of sedation depths: minimal
sedation (anxiolysis), moderate sedation
(conscious sedation), deep sedation, and general
anesthesia (5). Each level has distinct
implications for motion control and safety in the
MRI environment.
Observational studies report that moderate
sedation achieves acceptable success rates, but
imaging failure due to motion still occurs in 10–
30% of cases (5). Deep sedation and general
anesthesia achieve higher rates of successful
imaging with lower motion artifact rates,
typically exceeding 95% success. However,
deeper levels of sedation carry risks of airway
complications, including laryngospasm,
coughing, and airway obstruction, that may
necessitate scan interruption. The choice of
sedation depth must be individualized based on
patient characteristics, imaging requirements,
and institutional capabilities (5). This reflects a
fundamental trade-off between achieving
reliable immobility and maintaining airway and
respiratory safety.
3.3. Pharmacological Agents
3.3.1.Propofol
Propofol remains the most reliable agent for
MRI sedation due to its rapid onset, short
context-sensitive half-time, and high efficacy in
achieving immobility (7,8). Meta-analyses in
pediatric populations demonstrate that it
provides shorter onset of sedation
(approximately 6 minutes faster than dex-
medetomidine) and faster recovery times (7).
Image quality with propofol-based sedation is
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consistently rated as good to excellent, with
successful scan completion rates exceeding 99%
in large registry studies (9).
However, propofol causes dose-dependent
respiratory depression and upper airway
obstruction, particularly at deeper sedation
levels (9). Airway interventions (jaw thrust,
oral/nasal airway placement, positive-pressure
ventilation) are required in 15-45% of cases,
depending on patient population and dosing (10).
Propofol also produces hemodynamic effects,
including hypotension, though these are
generally mild and well-tolerated in healthy
patients (7,11). This reflects a fundamental
trade-off between reliability of immobility and
respiratory safety.
3.3.2. Dexmedetomidine
Dexmedetomidine, an α2-adrenergic agonist,
offers unique advantages for MRI sedation
through its preservation of respiratory drive and
minimal respiratory depression (8). Studies
show successful sedation rates of 62-95% with
dexmedetomidine, with higher success when
combined with other agents (12–14). Intranasal
dexmedetomidine has emerged as an effective
needle-free option for pediatric patients, with
efficacy dependent on dose and patient selection
(12,14,15). The main limitations of
dexmedetomidine include longer onset time
(typically 7-15 minutes for adequate sedation),
dose-dependent bradycardia and hypotension
(occurring in 5-20% of patients), and prolonged
recovery compared to propofol (16,17). Some
studies report that dexmedetomidine
monotherapy may result in inferior image
quality, likely due to insufficient sedation depth
or arousal during acoustic stimulation (16).
3.3.3. Combination Therapy
Recent evidence supports combining low-dose
dexmedetomidine with propofol to optimize
both efficacy and safety. Research shows that
dexmedetomidine preloading followed by
propofol infusion reduces total propofol
requirements, decreases airway interventions,
and improves hemodynamic stability without
prolonging recovery time (8). This approach
may be especially useful in balancing the
respiratory safety of dexmedetomidine with the
reliable immobility provided by propofol.
3.3.4. Sevoflurane
Inhaled sevoflurane provides effective sedation
for MRI with success rates approaching 98%
(12). Its non-irritating properties and rapid
titratability make it suitable for pediatric
patients. However, sevoflurane requires
specialized MRI-compatible anesthesia
machines or extended breathing circuits, as well
as scavenging systems for waste-gas
management (5). Recovery times are
intermediate between propofol and dexme-
detomidine. Despite its efficacy, use of
sevoflurane is often limited by logistical and
equipment-related constraints in the MRI
environment.
3.3.5. Other Agents
Traditional agents, including midazolam, chloral
hydrate, and pentobarbital, are still used,
particularly for needle-free sedation in young
children (12). However, these agents generally
have lower success rates (36-94%), prolonged
and unpredictable recovery times, and higher
rates of paradoxical agitation compared to
propofol, dexmedetomidine, or sevoflurane
(12,13). These limitations make them less
suitable for modern MRI practice, particularly
when high-quality imaging and rapid recovery
are required.
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3.4. Airway Management and Motion
Artifacts
An important but often overlooked source of
motion artifacts is pharyngeal micromotion
resulting from airway obstruction during
sedation. When sedation causes pharyngeal
muscle relaxation, patients may develop snoring,
partial airway obstruction, and associated head
micromotion, which degrades image quality,
particularly in neuroimaging (6).
A retrospective study comparing airway
management strategies found that supraglottic
airway devices significantly improved MRI
image quality compared to no airway device
(mean combined quality score 27.3 vs 22.0, P <
0.0001) (6). The supraglottic airway eliminated
snoring-related vibrations and micromotion
while maintaining spontaneous ventilation.
Endotracheal intubation provides the highest
image quality scores but requires general
anesthesia and more invasive airway
management (6). This highlights that motion
artifacts are not solely related to sedation depth
but also to airway management.
These findings suggest that for patients requiring
deep sedation or general anesthesia, especially
during high-resolution neuroimaging,
supraglottic airway placement should be
considered to optimize image quality by
reducing micromotion artifacts (6,18).
3.5. Safety Considerations in the MRI
Environment
The American Society of Anesthesiologists
Practice Advisory emphasizes multiple safety
considerations unique to the MRI environment.
The strong magnetic field poses risks to
ferromagnetic objects and can interfere with
implanted devices, including pacemakers and
nerve stimulators. In addition, all equipment
must be appropriately labeled as MRI-safe,
MRI-conditional, or MRI-unsafe (5).
Monitoring in the MRI environment may be
limited by magnetic field interference and
radiofrequency artifacts (5). The Task Force
recommends that monitoring for MRI
sedation/anesthesia should mirror standards for
other locations, including continuous pulse
oximetry, blood pressure monitoring,
electrocardiography, and end-tidal CO2
monitoring for all patients receiving deep
sedation or those whose ventilation cannot be
directly observed during moderate sedation. The
advisory also emphasizes that pulse oximetry is
not a substitute for ventilatory monitoring, as
oxygenation and ventilation are separate
physiological processes (5).
Patient access is restricted when the patient is
positioned within the scanner bore, potentially
delaying emergency interventions (5).
Anesthesiologists should implement clear
emergency protocols, ensure MRI-safe
resuscitation equipment is immediately
available, and maintain visual observation of
patients through direct line-of-sight or video
monitoring (5,19).
3.6. Pediatric Populations
Children account for the majority of patients
requiring sedation/anesthesia for MRI.
Systematic reviews show variable success rates
for needle-free sedation techniques: oral chloral
hydrate (94%), intranasal dexmedetomidine (62-
95%), oral midazolam (36%), and inhaled
sevoflurane (98%) (12). Intravenous propofol
with or without dexmedetomidine achieves the
highest success rates (> 95%) with acceptable
safety profiles (7,11).
Adverse events during pediatric MRI sedation
are generally minor, including transient oxygen
desaturation, airway obstruction requiring
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intervention, and emergence delirium (5,8).
Serious adverse events (aspiration, cardiac
arrest, unplanned hospital admission) are rare,
occurring in less than 0.1% of cases when
appropriate monitoring and personnel are
present (8).
3.7. Neurodevelopmental Considerations
Concerns about anesthetic neurotoxicity in
young children have emerged from animal
studies demonstrating neuroapoptosis and
functional deficits after exposure to GABA
agonists and NMDA antagonists (20,21). The
FDA issued a warning in 2016 regarding the
potential effects of repeated or prolonged
anesthesia on brain development in children
under 3 years (18).
Reassuringly, large prospective human studies,
including the GAS trial and the PANDA study,
have not demonstrated neurodevelopmental
deficits from single, brief anesthetic exposures in
infancy (18,20,22). Evidence suggests that
multiple anesthetic exposures (≥3 procedures) or
prolonged cumulative anesthesia duration may
be associated with small deficits in cognitive
testing and increased behavioral problems,
although residual confounding from underlying
medical conditions cannot be excluded
(9,21,23). These findings support a balanced
approach, that minimizes unnecessary exposure
while avoiding delays in clinically indicated
imaging.
For children requiring repeated MRI
examinations, the risks and benefits of
sedation/anesthesia must be carefully weighed
(18). Strategies to minimize exposure include
optimizing patient preparation to attempt non-
sedated imaging when feasible, using faster
imaging sequences, and consolidating multiple
imaging studies into single sessions when
possible (18).
3.8. Special Populations
Certain patient populations require tailored
anesthetic approaches during MRI. Those with
mucopolysaccharidosis and other conditions
associated with difficult airways may benefit
from dexmedetomidine rather than propofol to
reduce the need for airway intervention (10). In
contrast, critically ill patients requiring MRI
present additional challenges related to
transport, monitoring, and hemodynamic
instability (5). Claustrophobic adults may
require only anxiolysis or light sedation, so in
this context, propofol appears more effective
than dexmedetomidine (16). These examples
highlight the importance of individualizing
anesthetic strategies based on patient-specific
risks and procedural requirements.
4. Discussion
Anesthetic strategy is a key determinant of MRI
success in patients unable to remain motionless.
The optimal approach must be individualized
based on patient characteristics, imaging
requirements, and institutional resources.
For pediatric patients, propofol-based sedation
(with or without dexmedetomidine) provides the
most reliable combination of high success rates,
excellent image quality, and acceptable safety
when administered by appropriately trained
personnel with proper monitoring (7,9,11).
Dexmedetomidine offers advantages for patients
at higher risk of airway complications and
provides a needle-free option via intranasal
administration, though with longer onset and
recovery times (10,12,14).
The recognition that airway obstruction during
sedation can, in turn, cause motion artifacts
through pharyngeal micromotion is a critical and
often underrecognized contributor to image
degradation (6). For high-resolution neuro-
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imaging under deep sedation or general
anesthesia, supraglottic airway devices may
improve image quality while maintaining
spontaneous ventilation and avoiding the
invasiveness of endotracheal intubation (6,18).
This shifts the focus from sedation depth alone
to the combined role of sedation and airway
management in motion control. Safety in the
MRI environment requires a structured approach
that includes appropriate patient screening, use
of MRI-conditional equipment, comprehensive
monitoring, including capnography, mainte-
nance of visual observation, and preparation for
emergencies in a location with restricted access
(5,19). Adherence to professional society
guidelines is essential. The concern about
anesthetic neurotoxicity in young children, while
based on compelling animal data, has not been
substantiated for single, brief exposures in
human studies (18,20–22). Nevertheless, it is
advisable to limit unnecessary anesthetic
exposures in young children, particularly
repeated procedures (9,18,23). This can be
achieved through patient preparation programs,
faster imaging sequences, and consideration of
non-sedated imaging when feasible.
Future research directions include the
development of ultra-fast imaging sequences
that could reduce or eliminate the need for
sedation, refinement of combination
pharmacological approaches to optimize
efficacy and safety, integration of advanced
motion correction algorithms with anesthetic
strategies, and continued analysis of long-term
neurodevelopmental outcomes in children
requiring repeated anesthesia.
5. Conclusions
Despite technical advances, motion artifacts
remain a major limitation of MRI. However,
current evidence indicates that they can be
substantially reduced through appropriate
anesthetic planning, optimized airway
management, and strict adherence to MRI-
specific safety standards. Propofol and
dexmedetomidine are currently the most
effective pharmacological options, either alone
or in combination, and the choice between them
should be guided by the clinical context, airway
risk, and imaging requirements.
Importantly, airway-related micromotion
represents an underrecognized contributor to
image degradation, highlighting the importance
to incorporate airway management into motion-
reduction strategies. The use of supraglottic
airway devices may improve image quality in
selected cases while preserving spontaneous
ventilation. Ensuring safety in the MRI
environment requires strict adherence to
established protocols, including appropriate
monitoring and MRI-compatible equipment.
In pediatric patients, available evidence is
reassuring regarding single brief anesthetic
exposures, although minimizing repeated
anesthesia remains advisable. Further
improvements are likely to arise from the
integration of optimized anesthetic techniques
with advances in imaging technology and
motion correction methods.
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