Scoring system for periventricular leukomalacia in infants with congenital heart disease

Abstract

Background Currently two magnetic resonance imaging (MRI) methods have been used to assess periventricular leukomalacia (PVL) severity in infants with congenital heart disease: manual volumetric lesion segmentation and an observational categorical scale. Volumetric classification is labor intensive and the categorical scale is quick but unreliable. We propose the quartered point system (QPS) as a novel, intuitive, time-efficient metric with high interrater agreement. Methods QPS is an observational scale that asks the rater to score MRIs on the basis of lesion size, number, and distribution. Pre- and postoperative brain MRIs were obtained on term congenital heart disease infants. Three independent observers scored PVL severity using all three methods: volumetric segmentation, categorical scale, and QPS. Results Hundred and thirty-five MRIs were obtained from 72 infants; PVL was seen in 48 MRIs. Volumetric measurements among the three raters were highly concordant (ρc = 0.94–0.96). Categorical scale severity scores were in poor agreement between observers (κ = 0.17) and fair agreement with volumetrically determined severity (κ = 0.26, respectively). QPS scores were in very good agreement between observers (κ = 0.82) and with volumetric severity (κ = 0.81). Conclusion QPS minimizes training and sophisticated radiologic analysis and increases interrater reliability. QPS offers greater sensitivity to stratify PVL severity and has the potential to more accurately correlate with neurodevelopmental outcomes.

Perioperative neonatal brain injury is associated with worse school‐age neurodevelopment in children with critical congenital heart disease

“…Motor performance at the age of 6 years was generally below the normative mean in this population of children with CHD, which is in line with previous follow-up studies in children with CHD. 15 In this study, almost all children Fine motor scaled score 13 (11)(12)(13)(14)(15) 10 (8-12) À3 (À5 to À1)…”

“…Also, children with a below-average Full-scale IQ showed almost 10% smaller neonatal brain volumes, especially of basal ganglia and thalamus and brainstem, compared with children with an average or above average IQ. À3 (À11 to 4) À4 (À12 to 4) Fine motor scaled score 12 (10-15) 12 (11)(12)(13)(14) 0 (À2 to 2) 0 (À2 to 2) Gross motor scaled score 9 (8-10) 8 (6-9) À1 (À3 to 1) À1 Over the last few decades high incidences of WMI in neonates with critical CHD have been reported. 5,6 WMI is associated with poor neurodevelopmental outcome in neonates born preterm; 12 however, the impact of WMI on childhood outcomes in children with CHD is, as yet, unreported.…”

Subcentimeter epilepsy surgery targets by resting state functional magnetic resonance imaging can improve outcomes in hypothalamic hamartoma

“…A trained expert must grade images both to categorize signal as noise versus the signals of interest and to determine the presence or absence of rs‐fMRI connectivity of the HH with the rest of the brain. Thus, this method is prone to the same subjectivities and biases as nearly all clinically determined radiographic images, highlighting an area of potential technique improvement …”

Neuroimaging, cardiovascular physiology, and functional outcomes in infants with congenital heart disease

“…White matter injury (WMI) is described in full‐term neonates with CHD with remarkably high incidence . White matter lesions are characterized as hypo‐ and hyper‐intense on T2‐ and T1‐weighted imaging respectively, and scoring systems differ between research groups . In CHD, white matter lesions can often be found in the watershed areas (areas perfused by the most distal branches of two main cerebral arteries) which are usually a result of (acute) hypoperfusion.…”

“…52,59,74-77 White matter lesions are characterized as hypo-and hyper-intense on T2-and T1-weighted imaging respectively, and scoring systems differ between research groups. 78 In CHD, white matter lesions can often be found in the watershed areas (areas perfused by the most distal branches of two main cerebral arteries) which are usually a result of (acute) hypoperfusion. In neonates, autoregulatory mechanisms are still vulnerable as they lack the full ability to cope with fluctuations in cerebral perfusion.…”