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

作者：Trivedi Shamik B^*; Vesoulis Zachary A; Rao Rakesh; Liao Steve M; Shimony Joshua S; McKinstry Robert C; Mathur Amit M

来源：Pediatric Radiology, 2017, 47(11): 1491-1499.

DOI：10.1007/s00247-017-3893-y

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

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

• 出版日期2017-10