Validation of an MRI Brain Injury and Growth Scoring System in Very Preterm Infants Scanned at 29-to 35-Week Postmenstrual Age
Validation of an MRI Brain Injury and Growth Scoring System in Very Preterm Infants Scanned at 29-to 35-Week Postmenstrual Age
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DOI：
10.3174/ajnr.a5191
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发表时间：
2017-07-01
影响因子：
3.5
通讯作者：
Boyd, R. N.
中科院分区：
文献类型：
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作者：
George, J. M.;Fiori, S.;Boyd, R. N.
背景与目的：在有效的磁共振成像评分系统出现之前，足月前脑磁共振成像的诊断和预后潜力有限。本研究旨在验证脑损伤和发育障碍的磁共振成像评分系统，该系统适用于孕龄< 31周出生的经后29至35周的婴儿。材料和方法：在一项前瞻性队列研究中，83名婴儿在月经后29至35周(平均32(+2)+/- 1（+3）周；男性49例，中位妊娠28（+4）周出生；范围：23(+6)-30（+6）周；平均出生体重1068±312 g)。77名婴儿在足月年龄(平均40（+6)+/- 1（+3）周）进行了第二次磁共振扫描。使用改进的评分系统对结构图像进行评分，该评分系统生成WM、皮质灰质、深部灰质、小脑和整体评分。12个月矫正年龄（平均12个月4天+/- 1（+2）周）的结果包括Bayley婴幼儿发育量表，第3版（Bayley III）和神经-感觉运动发育评估。结果：早期MR成像全局、WM和深灰质评分与Bayley III运动（全局评分回归系数beta = -1.31; 95% CI, -2.39至-0.23;P = 0.02）、认知（beta = -1.52; 95% CI, -2.39至-0.65;P < 0.01）和神经感觉运动发育评估结果（beta = -1.73; 95% CI, -3.19至-0.28;P = 0.02）呈负相关。早期MR成像小脑评分与神经感觉运动发育评估呈负相关（β = -5.99; 95% CI, -11.82至-0.16;P = 0.04）。结果在期等值年龄的MR成像中得到了再次证实。结论：该临床可用的磁共振成像评分系统适用于经后29至35周的极早产儿。它能够在现行足月等效年龄标准之前识别有不良后果风险的婴儿。
BACKGROUND AND PURPOSE: 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.MATERIALS AND METHODS: Eighty-three infants in a prospective cohort study underwent early 3T MR imaging between 29 and 35 weeks' postmenstrual age (mean, 32(+2) +/- 1(+3) weeks; 49 males, born at median gestation of 28(+4) weeks; range, 23(+6)-30(+6) weeks; mean birthweight, 1068 +/- 312 g). Seventy-seven infants had a second MR scan at term-equivalent age (mean, 40(+6) +/- 1(+3) 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(+2) weeks) consisted of the Bayley Scales of Infant and Toddler Development, 3rd ed. (Bayley III), and the Neuro-Sensory Motor Developmental Assessment.RESULTS: Early MR imaging global, WM, and deep gray matter scores were negatively associated with Bayley III motor (regression coefficient for global score beta = -1.31; 95% CI, -2.39 to -0.23; P = .02), cognitive (beta = -1.52; 95% CI, -2.39 to -0.65; P < .01) and the Neuro-Sensory Motor Developmental Assessment outcomes (beta = -1.73; 95% CI, -3.19 to -0.28; P = .02). Early MR imaging cerebellar scores were negatively associated with the Neuro-Sensory Motor Developmental Assessment (beta = -5.99; 95% CI, -11.82 to -0.16; P = .04). Results were reconfirmed at term-equivalent-age MR imaging.CONCLUSIONS: 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.