Investigators at St Francis Medical Center, Cape Girardeau, MO, and multiple centers in the US, using a database from the Vermont Oxford Network Registry, studied the pattern of use and findings of computed tomography, MRI, and intracranial ultrasound in the evaluation of infants with neonatal encephalopathy. CT scans were performed on 933 of 4107 (22.7%) infants, and 100 of 921 (10.9%) of those received multiple CT scans. Compared with MRI, CT provided less detailed evaluation of cerebral injury, but was more sensitive than cranial ultrasound for hemorrhage and deep brain structural abnormalities. Despite concerns over potential harm from radiation exposure and a diagnostic value inferior to that of MRI, CT is commonly used for neonatal imaging. Data collected in this study suggest that cranial ultrasound for screening, followed by MRI is more appropriate than CT at any stage of evaluation of infants with neonatal encephalopathy. [1]

COMMENTARY. Fetal exposure to radiation is linked to neurologic abnormalities [2], and infant medical radiation exposure is associated with impaired cognitive development [3]. The Image Gently education campaign in radiology promotes reduction of the frequency of CT scanning [4], but further efforts by caregivers of newborns are needed to limit the use of CT in evaluation of neonatal encephalopathy [5].