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- Title
A validated clinical MRI injury scoring system in neonatal hypoxic-ischemic encephalopathy.
- Authors
Trivedi, Shamik; Vesoulis, Zachary; Rao, Rakesh; Liao, Steve; Shimony, Joshua; McKinstry, Robert; Mathur, Amit; Trivedi, Shamik B; Vesoulis, Zachary A; Liao, Steve M; Shimony, Joshua S; McKinstry, Robert C; Mathur, Amit M
- Abstract
<bold>Background: </bold>Deep nuclear gray matter injury in neonatal hypoxic-ischemic encephalopathy (HIE) is associated with worse neurodevelopmental outcomes. We previously published a qualitative MRI injury scoring system utilizing serial T1-weighted, T2-weighted and diffusion-weighted imaging (DWI), weighted for deep nuclear gray matter injury.<bold>Objectives: </bold>To establish the validity of the MRI scoring system with neurodevelopmental outcome at 18-24 months.<bold>Materials and Methods: </bold>MRI scans from neonates with moderate to severe HIE treated with therapeutic hypothermia were evaluated. Signal abnormality was scored on T1-weighted, T2-weighted and DWI sequences and assessed using an established system in five regions: (a) subcortical: caudate nucleus, globus pallidus and putamen, thalamus and the posterior limb of the internal capsule; (b) white matter; (c) cortex, (d) cerebellum and (e) brainstem. MRI injury was graded as none, mild, moderate or severe. Inter-rater reliability was tested on a subset of scans by two independent and blinded neuroradiologists. Surviving infants underwent the Bayley Scales of Infant and Toddler Development-III (Bayley-III) at 18-24 months. Data were analyzed using univariate and multivariate linear and logistic regression.<bold>Results: </bold>Fifty-seven eligible neonates underwent at least one MRI scan in the first 2 weeks of life. Mean postnatal age at scan 1 was 4±2 days in 50/57 (88%) neonates and 48/54 (89%) surviving infants underwent scan 2 at 10±2 days. In 54/57 (95%) survivors, higher MRI injury grades were significantly associated with worse outcomes in the cognitive, motor and language domains of the Bayley-III.<bold>Conclusion: </bold>A qualitative MRI injury scoring system weighted for deep nuclear gray matter injury is a significant predictor of neurodevelopmental outcome at 18-24 months in neonates with HIE.
- Subjects
DIAGNOSIS of neonatal diseases; MAGNETIC resonance imaging of the brain; GRAY matter (Nerve tissue); BRAIN injuries; NEURAL development; PEDIATRIC radiology; DIAGNOSIS
- Publication
Pediatric Radiology, 2017, Vol 47, Issue 11, p1491
- ISSN
0301-0449
- Publication type
journal article
- DOI
10.1007/s00247-017-3893-y