Brain MRI Technical Guidelines
Dr. Barkovich Paper on Conducting an MRI (2017)
MRI scanning of the brain and spine
Naevus International’s current recommendation is based on the whole of the published medical literature is that any child born with two or more CMN of any size or site should have a routine MRI scan of the brain and spine in the first year of life, preferably before the age of 6 months. It is not possible to say that MRI abnormalities could never occur in children with only one CMN at birth, but the risk is much less. If the child is well at the age of two years and hasn’t had a scan, then a scan is not needed in retrospect as even if there is something there it is unlikely to require intervention.
The reasoning behind this recommendation is the following:
1. The MRI scan result can be divided into the following 3 categories:
- a. normal
- b. intraparenchymal melanosis only (see above)
- c. all other abnormalities on MRI scan (see above)
2. The MRI results are the best predictor of clinical problems
- a. Normal MRI – low chance of melanoma in childhood; low chance of seizures in childhood; low chance of neurodevelopmental problems (and where they do occur they are generally mild)
- b. Intraparenchymal melanosis only – low chance of melanoma in childhood; some risk of seizures(fits); some risk of neurodevelopmental problems
- c. All other abnormalities on MRI scan – this depends very much on each individual case which will be assessed by the individual medical team, but if the group is considered as a whole: some risk of melanoma; considerable risk of needing neurosurgery; considerable risk of seizures (fits); considerable risk of neurodevelopmental problems
3. The MRI results, therefore, guide clinical management
- Normal MRI – scan doesn’t need to be repeated routinely, no routine monitoring of child development
- Intraparenchymal melanosis only – scan doesn’t need to be repeated routinely, yearly monitoring of child development until school age, and if problems are detected, appropriate early intervention for developmental support, and the institution of a plan for school support
- All other abnormalities on MRI scan – individual specialist management is recommended until the child is clearly stable – the scan will likely need to be repeated to see if any changes, neurosurgery may be needed, and risk of melanoma needs to be monitored
Nevus Outreach, Inc., Releases Best Practice Guidelines
The Research Committee of Nevus Outreach, Inc. in conjunction with the Expert Committee has proposed a ‘Working’ model of best practices for persons born with Congenital Melanocytic Nevus (CMN). These practices reflect the opinions of the world’s leading experts for CMN but should not be construed as a substitute for the guidance and opinion of you or your child’s physician.
This model applies to every child born with at least one CMN >3cm, >20 satellites, or both. This is to establish a baseline for the patient given the understanding that developmental delays, disease, and even death are possible sequelae.