Early Conventional MRI for Prediction of Neurodevelopmental Impairment in Extremely-Low-Birth-Weight Infants.
Early Conventional MRI for Prediction of Neurodevelopmental Impairment in Extremely-Low-Birth-Weight Infants.
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作者：
Slaughter LA;Bonfante-Mejia E;Hintz SR;Dvorchik I;Parikh NA
极低出生体重（ELBW，≤ 1000 g）婴儿神经发育障碍的风险很高。常规的脑MRI在相当的任期年龄越来越多地用于预测的结果。然而，最佳预测模型仍有待确定，特别是对于认知结果。评价数据驱动MRI评分系统预测神经发育障碍的准确性。122名ELBW婴儿在足月时进行了脑部MRI检查。采用标准化算法对常规MRI结果进行评分，并使用多变量回归模型进行测试，以预测神经发育障碍，定义为18 - 24个月矫正年龄时的以下一种或多种：脑瘫、双侧失明、需要放大的双侧耳聋和/或认知/语言延迟。结果进行了比较，一个常用的评分系统。在多变量分析中，只有中度至重度脑回发育迟缓是整体神经发育障碍的重要预测因素（比值比[OR]：12.6，95% CI：2.6，62.0; P <0.001）。中度至重度脑回成熟延迟也可预测认知延迟、认知延迟/死亡和神经发育障碍/死亡。弥漫性囊性异常是脑性瘫痪的重要预测因素（OR：33.6，95% CI：4.9，229.7; P <0.001）。这些预测因子对上述结果显示出高特异性（范围：94%-99%）但低敏感性（30%-67%）。白色或灰质分数，使用一个常用的评分系统，并没有显示出显着的关联与神经发育障碍。在我们的队列中，在足月年龄的常规MRI在预测神经发育结果方面表现出高度的特异性。然而，灵敏度是次优的，这表明需要额外的临床因素和生物标志物来实现准确的预测。
Extremely low birth weight (ELBW, ≤1000g) 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. To evaluate the accuracy of a data-driven MRI scoring system to predict neurodevelopmental impairments. 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. In multivariable analyses, only moderate to severe gyral maturational delay was a significant predictor of overall neurodevelopmental impairment (Odds Ratio [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. 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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