Utilizing Neonatal Brain Imaging to Predict Neurodevelopmental Outcomes

For 40 years, clinicians have sought to utilize neonatal neuroimaging results to not only aid in diagnosis and support clinical decision making, but also attempt to predict neurodevelopmental outcomes in high-risk infants. This effort has been supported by rapidly advancing imaging technology and a wealth of research correlating neuroimaging results with short-term outcomes. The univariate nature of imaging and dynamic pathophysiology of neonatal brain injury, however, have resulted in widely variable sensitivity and specificity of neuroimaging in predicting development outside of the first 2 years of life. This chapter reviews the history and current state of brain imaging for predicting later neurodevelopmental outcomes in high-risk neonates. Imaging modalities that are discussed include magnetic resonance imaging (MRI), ultrasound, computed tomography, as well as more recent magnetic resonance modalities such as magnetic resonance spectroscopy, arterial spin-labelling perfusion MRI, and diffusion tensor imaging. Currently, the predictive capabilities of isolated neuroimaging results do not adequately allow for either the exclusion of high-risk infants from structured follow-up or the selection of infants for additional therapies. Combining modes and timing of imaging, however, may allow for improved predictive values. As neuroimaging research evolves, it will be important to consider how investigators may utilize neuroimaging to improve outcomes for neonates rather than solely anticipating outcomes.