CT versus MR in neonatal brain imaging at term.
BACKGROUND
Recent reports have highlighted the lifetime risk of malignancy from using ionizing radiation in pediatric imaging. Computed tomography (CT), which uses ionizing radiation, is employed extensively for neonatal brain imaging of term infants. Magnetic resonance (MR) provides an alternative that does not use ionizing radiation.


OBJECTIVE
The purpose of this study was to assess the cross-modality agreement and interobserver agreement of CT and MR brain imaging of the term or near-term neonate.


METHODS
Brain CT and MR images of 48 neonates were retrospectively reviewed by two pediatric neuroradiologists. CT and MR examinations had been obtained within 72 h of one another in all patients. CT was obtained with 5 mm collimation (KV=120, mAs=340). MR consisted of T1-weighted imaging (TR/TE=300/14; 4-mm slice thickness/1-mm gap), T2-weighted imaging (TR/TE/etl= 3000/126/16; 4-mm slice thickness/1-mm gap), and line scan diffusion imaging (LSDI) (TR/TE/b factor=1258/63/750; nominal 4-mm slice thickness/3-mm gap). The brain was categorized as normal or abnormal on both CT and MR.


RESULTS
Ischemic injury was the most common brain abnormality demonstrated. McNemar's test indicated no significant difference between CT and MR test results for reader 1 (P=0.22) or reader 2 (P=0.45). The readers agreed on the presence or absence of abnormality on CT in 40 patients (83.3%) and on MR in 45 patients (93.8%). For CT, the kappa coefficient indicated excellent interobserver agreement (kappa=0.68), although the lower limit of the 95% confidence interval extends to kappa=0.55, which indicates only good-to-moderate agreement. For MR, the kappa coefficient indicated almost perfect interobserver agreement (kappa=0.88) with the 95% confidence interval extending to a lower limit of kappa=0.76, which represents excellent agreement. CONCLUSION. Because MR demonstrates findings similar to CT and has greater interobserver agreement, it appears that MR is a superior test to CT in determining brain abnormalities in the term neonate. Furthermore, since MR eliminates the use of ionizing radiation, a putative cause of malignancy, it should be the standard in neonatal brain imaging. Future efforts should be directed to improving neonatal access to MR to avoid the routine use of CT in infants.
Department of Radiology, Children's Hospital Medical Center, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA. Richard.Robertson@tch.harvard.edu
Richard L
RL
Robertson
Caroline D
CD
Robson
David
D
Zurakowski
Sharon
S
Antiles
Keith
K
Strauss
Robert V
RV
Mulkern
D001921:Brain / Q000033:anatomy & histology* / Q000000981:diagnostic imaging*; D002545:Brain Ischemia / Q000175:diagnosis; D002544:Cerebral Infarction / Q000175:diagnosis; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D015588:Observer Variation; D011829:Radiation Dosage; D011835:Radiation Protection; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed