Validation of an MRI Brain Injury and Growth Scoring System in Very Preterm Infants Scanned at 29- to 35-Week Postmenstrual Age

• Published in: American journal of neuroradiology : AJNR Vol. 38; no. 7; pp. 1435 - 1442
• Main Authors: George, J M, Fiori, S, Fripp, J, Pannek, K, Bursle, J, Moldrich, R X, Guzzetta, A, Coulthard, A, Ware, R S, Rose, S E, Colditz, P B, Boyd, R N
• Format: Journal Article
• Language: English
• Published: United States American Society of Neuroradiology 01.07.2017
• Subjects: Adult; Age; Birth weight; Brain; Brain - diagnostic imaging; Brain - growth & development; Brain Injuries - congenital; Brain Injuries - diagnostic imaging; Brain injury; Cerebellum; Cerebellum - diagnostic imaging; Cerebellum - growth & development; Child Development; Cognitive ability; Cohort Studies; Cortex; Diagnostic systems; Discharge; Equivalence; Female; Gestation; Gestational age; Gray Matter - diagnostic imaging; Gray Matter - growth & development; Head injuries; Humans; Infant; Infant, Extremely Premature; Infant, Newborn; Infants; Magnetic resonance imaging; Magnetic Resonance Imaging - methods; Males; Neuroimaging; Observer Variation; Pediatrics; Pregnancy; Premature babies; Prospective Studies; Regression coefficients; Reproducibility of Results; Risk Factors; Substantia grisea; Traumatic brain injury; White Matter - diagnostic imaging; White Matter - growth & development
• ISSN: 0195-6108; 1936-959X
• DOI: 10.3174/ajnr.A5191

The diagnostic and prognostic potential of brain MR imaging before term-equivalent age is limited until valid MR imaging scoring systems are available. This study aimed to validate an MR imaging scoring system of brain injury and impaired growth for use at 29 to 35 weeks postmenstrual age in infants born at <31 weeks gestational age. Eighty-three infants in a prospective cohort study underwent early 3T MR imaging between 29 and 35 weeks' postmenstrual age (mean, 32 ± 1 weeks; 49 males, born at median gestation of 28 weeks; range, 23 -30 weeks; mean birthweight, 1068 ± 312 g). Seventy-seven infants had a second MR scan at term-equivalent age (mean, 40 ± 1 weeks). Structural images were scored using a modified scoring system which generated WM, cortical gray matter, deep gray matter, cerebellar, and global scores. Outcome at 12-months corrected age (mean, 12 months 4 days ± 1 weeks) consisted of the Bayley Scales of Infant and Toddler Development, 3rd ed. (Bayley III), and the Neuro-Sensory Motor Developmental Assessment. Early MR imaging global, WM, and deep gray matter scores were negatively associated with Bayley III motor (regression coefficient for global score β = -1.31; 95% CI, -2.39 to -0.23; = .02), cognitive (β = -1.52; 95% CI, -2.39 to -0.65; < .01) and the Neuro-Sensory Motor Developmental Assessment outcomes (β = -1.73; 95% CI, -3.19 to -0.28; = .02). Early MR imaging cerebellar scores were negatively associated with the Neuro-Sensory Motor Developmental Assessment (β = -5.99; 95% CI, -11.82 to -0.16; = .04). Results were reconfirmed at term-equivalent-age MR imaging. This clinically accessible MR imaging scoring system is valid for use at 29 to 35 weeks postmenstrual age in infants born very preterm. It enables identification of infants at risk of adverse outcomes before the current standard of term-equivalent age.