Early Conventional MRI for Prediction of Neurodevelopmental Impairment in Extremely-Low-Birth-Weight Infants

Abstract

Background: Extremely-low-birth-weight (ELBW; ≤1,000 g) infants are at high risk for neurodevelopmental impairments. Conventional brain MRI at term-equivalent age is increasingly used for prediction of outcomes. However, optimal prediction models remain to be determined, especially for cognitive outcomes. Objective: The aim was to evaluate the accuracy of a data-driven MRI scoring system to predict neurodevelopmental impairments. Methods: 122 ELBW infants had a brain MRI performed at term-equivalent age. Conventional MRI findings were scored with a standardized algorithm and tested using a multivariable regression model to predict neurodevelopmental impairment, defined as one or more of the following at 18-24 months' corrected age: cerebral palsy, bilateral blindness, bilateral deafness requiring amplification, and/or cognitive/language delay. Results were compared with a commonly cited scoring system. Results: In multivariable analyses, only moderate-to-severe gyral maturational delay was a significant predictor of overall neurodevelopmental impairment (OR: 12.6, 95% CI: 2.6, 62.0; p < 0.001). Moderate-to-severe gyral maturational delay also predicted cognitive delay, cognitive delay/death, and neurodevelopmental impairment/death. Diffuse cystic abnormality was a significant predictor of cerebral palsy (OR: 33.6, 95% CI: 4.9, 229.7; p < 0.001). These predictors exhibited high specificity (range: 94-99%) but low sensitivity (30-67%) for the above outcomes. White or gray matter scores, determined using a commonly cited scoring system, did not show significant association with neurodevelopmental impairment. Conclusions: In our cohort, conventional MRI at term-equivalent age exhibited high specificity in predicting neurodevelopmental outcomes. However, sensitivity was suboptimal, suggesting additional clinical factors and biomarkers are needed to enable accurate prognostication.

Diagnostic accuracy of early magnetic resonance imaging to determine motor outcomes in infants born preterm: a systematic review and meta‐analysis

“…However, lower sensitivity means that some infants with normal MRI may progress to have adverse motor outcomes. This is consistent with studies of MRI at TEA . For determination of a later diagnosis of CP, sensitivity was more frequently higher than specificity, indicating that most infants who progress to CP were identified by abnormalities on MRI.…”

Advanced neuroimaging and its role in predicting neurodevelopmental outcomes in very preterm infants

“…Qualitative assessment of the presence of DEHSI exhibits low intra- and inter-rater reliability. 80,81 Even advanced MRI studies are susceptible to such concerns. Several of the advanced MRI studies in this review did not report the reliability of brain measurements and those that did usually did not report more robust measures such as within-subject standard deviation and repeatability.…”

Clinical neuroimaging in the preterm infant: Diagnosis and prognosis

“…Like WMA, qualitative GMA are usually stratified according to their degree of severity and distribution (cortical, subcortical, and/or cerebellar) ( Inder et al, 2003 , Kidokoro et al, 2013 , Woodward et al, 2006 ). Although GMA in preterm infants have often been associated with PVL, these could be difficult to detect by conventional MRI and, consequently, most neuroradiologists do not report these findings in clinical practice ( Slaughter et al, 2016 ).…”

“…Macrostructural and microstructural corpus callosum abnormalities that result from prematurity in very preterm infants also correlated with adverse neurodevelopmental outcomes at 2 years of age measured with the Bayley Scales of Infant Development (BSID-II) ( Thompson et al, 2012 ). On the other hand, GMA have also been associated with language, cognitive and motor delays and cerebral palsy at 18–24 months of age ( Slaughter et al, 2016 , Woodward et al, 2006 ). Omizzolo et al (2014) reported that abnormalities of the basal ganglia and the thalamus in very preterm infants were the strongest predictor of memory and learning performance outcomes at 7 years of age.…”