Routine Neuroimaging of the Preterm Brain

Abstract

Neuroimaging of the preterm infant is a common assessment performed in the NICU. Timely and focused studies can be used for diagnostic, therapeutic, and prognostic information. However, significant variability exists among neonatal units as to which modalities are used and when imaging studies are obtained. Appropriate timing and selection of neuroimaging studies can help identify neonates with brain injury who may require therapeutic intervention or who may be at risk for neurodevelopmental impairment. This clinical report reviews the different modalities of imaging broadly available to the clinician. Evidence-based indications for each modality, optimal timing of examinations, and prognostic value are discussed.

Neuroimaging at Term Equivalent Age: Is There Value for the Preterm Infant? A Narrative Summary

“…In addition, it offers an imaging modality free of exposure to ionizing radiation as opposed to computerized tomography (CT) scans [ 21 ]. A routine imaging schedule for preterm infants less than 32 weeks gestational age (GA) with the cranial US is now followed in neonatal intensive care units (NICU) [ 5 , 18 ]. In order to standardize the descriptions of injury documented on the cranial US, grading systems were developed by Papile et al [ 22 ] Table 1 and Volpe [ 23 ], with that from Papile being the most widely used to date.…”

“…Cranial US remains the NICU’s primary imaging tool worldwide [ 5 , 18 , 56 ]. This is related to its ease of use and cost-efficiency.…”

“…Recommendations from the American Academy of Neurology (AAN), the American Academy of Pediatrics (AAP), and the Canadian Pediatric Society (CPS) do not endorse routine MRI for preterm infants, regardless of cranial US findings [ 5 , 17 , 18 ]. Currently, updated guidance from both the AAP and CPS state that TEA MRI for infants should be considered mainly as a follow-up of abnormal cranial US results (e.g., severe IVH, PVL, and hydrocephalus) and following a conversation with the family regarding its limitations for estimation of long-term prognosis.…”

“…Currently, updated guidance from both the AAP and CPS state that TEA MRI for infants should be considered mainly as a follow-up of abnormal cranial US results (e.g., severe IVH, PVL, and hydrocephalus) and following a conversation with the family regarding its limitations for estimation of long-term prognosis. [ 5 , 18 , 105 , 134 , 136 ]. A “feed and wrap” technique is preferred should MRI be pursued [ 18 , 61 , 150 ].…”

“…This narrative summary will review the history and current state of brain imaging, focusing on cranial ultrasound and magnetic resonance imaging (MRI) in the preterm population to predict later neurodevelopmental outcomes. The updated guidelines from the American Academy of Neurology (AAN) [ 17 ], the American Academy of Pediatrics (AAP), and the Canadian Pediatric Society (CPS) [ 5 , 18 ] regarding MRI screening in this population will also be summarized.…”