Brain 3T magnetic resonance imaging in neonates: features and incidental findings from a research cohort enriched for preterm birth

Background and objectives The survival rate and patterns of brain injury after very preterm birth are evolving with changes in clinical practices. Additionally, incidental findings can present legal, ethical and practical considerations. Here, we report MRI features and incidental findings from a large, contemporary research cohort of very preterm infants and term controls. Methods 288 infants had 3T MRI at term-equivalent age: 187 infants born <32 weeks without major parenchymal lesions, and 101 term-born controls. T1-weighted, T2-weighted and Susceptibility-weighted imaging were used to classify white and gray matter injury according to a structured system, and incidental findings described. Results Preterm infants : 34(18%) had white matter injury and 4(2%) had gray matter injury. 51(27%) infants had evidence of intracranial haemorrhage, and 34(18%) had punctate white matter lesions (PWMLs). Incidental findings were detected in 12(6%) preterm infants. Term infants : No term infants had white or gray matter injury. Incidental findings were detected in 35(35%); these included intracranial haemorrhage in 22(22%), periventricular pseudocysts in 5(5%) and PWMLs in 4(4%) infants. From the whole cohort, 10(3%) infants required referral to specialist services. Conclusions One fifth of very preterm infants without major parenchymal lesions have white or gray matter abnormalities at term-equivalent age. Incidental findings are seen in 6% of preterm and 35% of term infants. Overall, 3% of infants undergoing MRI for research require follow-up due to incidental findings. These data should help inform consent procedures for research and assist service planning for centres using 3T neonatal brain MRI for clinical purposes. What is already known on this topic Neonatal MRI at term-equivalent age has established a common signature of preterm birth that includes diffuse white matter disease, reduced cortical gray matter complexity, and enlarged cerebrospinal fluid spaces. All neuroimaging has the potential to detect incidental findings. There are inter-cohort variations in the reported prevalence of brain imaging features associated with preterm birth and incidental findings in the neonatal population. What this study adds The prevalence of features of encephalopathy of prematurity identified on 3T brain MRI in a contemporaneous UK cohort without major parenchymal lesions imaged at term-equivalent age. The types and prevalence of incidental findings identified on 3T brain MRI in very preterm infants and term-born controls. How this study might affect research, practice or policy This study will support clinicians and researchers with informed consent processes, image interpretation, and service development.