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. 2016;110(1):47-54.
doi: 10.1159/000444179. Epub 2016 Apr 7.

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

Laurel A Slaughter  1 , Eliana Bonfante-Mejia, Susan R Hintz, Igor Dvorchik, Nehal A Parikh
Affiliations

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

Laurel A Slaughter et al. Neonatology. 2016.

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.

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Conflict of interest statement

CONFLICTS OF INTEREST

The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1. Cerebral maturation stages G2, G3, G4
Axial T2WI. (A) G2: The frontal and occipital cortex has similar number of convolutions. The frontal sulci are still quite shallow (arrow). The internal surface of the insula is more convoluted. (B) G3: The frontal and occipital cortex is folded and rich in sulci. Frontal sulci are obvious along the interhemispheric fissure. Occipital white matter is separated into strands by deeper sulci. Insula more convoluted and infolded (arrow). (C) G4: Frontal and occipital white matter separated into strands by deeper sulci. Insula completely infolded. Secondary gyri present- transverse and inferior temporal. Anterior (a) and posterior (p) orbital gyri. White matter still distinguishable from gray matter on T1.
Figure 2
Figure 2. Bayley scores in ELBW survivors with moderate or severe delayed gyral maturation
Mean scores were significantly lower in the group with moderate to severe delayed gyral maturation for Bayley Cognitive, Language, and combined Mental subtests (*P<0.001).
See this image and copyright information in PMC

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