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Editorial on ‘Effect of MRI on preterm infants and their families: a randomized trial with nested diagnostic and economic evaluation’.
Since the first published report of brain MRI in the early 1980s, its use has expanded to newborns. Brain MRI was initially used as a research tool to elucidate how the newborn brain develops, and alterations in the face of perinatal insults. Several studies in the mid-2000s identified robust relationships between the severity of white matter abnormality and neurodevelopmental outcomes in the first 2 years after birth.1 Since then, there have been a flurry of publications attesting to the predictive ability of neonatal brain MRI for a broad range of developmental outcomes to late childhood.1 From these observations, the use of MRI in preterm neonates expanded at some centres from diagnostic tool for suspected brain pathology, to a ‘routine screening tool’ for prediction of neurodevelopmental outcomes.
Not surprisingly, with the more widespread use of MRI and the large variability in what constitutes an MRI test (eg, timing of scan and sequences acquired), concerns have arisen. Issues such as the ‘poor’ sensitivity and specificity of MRI in predicting neurodevelopment and insufficient evidence that ‘routine’ term-equivalent MRI leads to improved long-term outcomes has led to recommendations ‘to avoid routine screening term-equivalent or discharge brain MRIs in preterm infants’.2 Yet, we have learnt that some brain injuries are most readily apparent on earlier MRI scans, and advanced quantitative analytic MRI techniques are more …
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