Comparative Diagnostic Performance of Early and Term MRI in Preterm Infants: a Diagnostic Test Accuracy Systematic review and Bayesian Meta-analysis.

Introduction Early identification of neurodisability and delay after preterm birth is critical for timely intervention. Term-equivalent magnetic resonance imaging (MRI) (36–44 weeks) is widely used for prognostication, earlier MRI (<36 weeks) may offer additional value. Methods To provide a comparative diagnostic test accuracy synthesis of early versus term‑equivalent MRI for motor and non‑motor neurodevelopmental outcomes, incorporating advanced imaging modalities including volumetric and diffusion measures, PubMed, Embase, Cochrane CENTRAL, Scopus, and Web of Science were searched to January 22nd, 2026. PRISMA-DTA guidelines were followed with PROSPERO registration (CRD42024528207). Studies enrolling preterm infants (<37 weeks) undergoing both early and term-equivalent MRI with neurodevelopment assessment between 12–36-months were included. Two reviewers extracted data and assessed bias risk. Meta-analysis used a Bayesian bivariate random-effects model pooling diagnostic metrics for presence of lesion, intraventricular haemorrhage, white matter injury, and cerebellar haemorrhage. Results Of 3,249 records screened, 30 studies met inclusion. Term-equivalent MRI lesion presence (diagnostic odds ratio (DOR)=14.17 vs 2.67; sensitivity 84% vs 76%; specificity 73% vs 45%) and white matter injury (DOR=5.92 vs 2.20; sensitivity 65% vs 52% and specificity 76% vs 67%) demonstrated superior predictivity than Early MRI. White matter injury at term best predicted motor outcomes (DOR=18.43). Volumetric and diffusion measures improved predictive accuracy, especially for cognitive outcomes. Heterogeneity in MRI protocols, biomarker definitions, and outcomes limited comparability and the modest study number reduced precision. Conclusion Term-equivalent MRI offers higher predictivity than Early MRI. Standardised scoring and multimodal integration are needed to optimise early risk stratification in preterm populations.