A multicenter randomized trial compared preterm infants less than 33 weeks at birth for whom results of both cranial ultrasound and cranial MRI at term gestation were available, to similar infants for whom only ultrasound results were available. Each group had more than 250 infants. The outcomes were maternal anxiety, measured by the state-trait anxiety inventory, prediction of neurodevelopment, health-related costs, and quality of life. Monitored at 14 days, 12 and 20 months, maternal anxiety decreased in both groups,but more so in the MRI & ultrasound group than in the ultrasound-only group. However the magnitude of decrease was not large. There were no differences in health-related quality of life. MRI predicted moderate or severe functional motor impairment at 20 months slightly better than ultrasound (area under the receiver operator characteristic curve 0.74 vs 0.64, p=0.01), but cost £315 more per infant. Adding the routine MRI to ultrasound increased costs and provided only modest benefits.