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Pediatr Radiol. 2017 Oct;47(11):1491-1499. doi: 10.1007/s00247-017-3893-y. Epub 2017 Jun 16.

A validated clinical MRI injury scoring system in neonatal hypoxic-ischemic encephalopathy.

Author information

1
Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics,, Washington University School of Medicine, One Children's Place, Campus Box 8116,, St. Louis, MO, 63110, USA. Trivedi_S@kids.wustl.edu.
2
Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics,, Washington University School of Medicine, One Children's Place, Campus Box 8116,, St. Louis, MO, 63110, USA.
3
Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, USA.

Abstract

BACKGROUND:

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.

OBJECTIVES:

To establish the validity of the MRI scoring system with neurodevelopmental outcome at 18-24 months.

MATERIALS AND METHODS:

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.

RESULTS:

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.

CONCLUSION:

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.

KEYWORDS:

Brain; Hypoxic-ischemic encephalopathy; Magnetic resonance imaging; Neonates; Neurodevelopmental outcome; Scoring system

PMID:
28623417
PMCID:
PMC6219383
DOI:
10.1007/s00247-017-3893-y
[Indexed for MEDLINE]
Free PMC Article

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