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.   ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by Theirworld (www.theirworld.org) and the Medical Research Council (MR/X003434/1, MR/X019535/1). ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The UK National Research Ethics Service (South East Scotland Research Ethics Committee) gave ethical approval for this work (16/SS/0154). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors.