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Published on: March 14, 2013
Cerebral maturation in premature infants: quantitative assessment using MR imaging
A M Childs1, L A Ramenghi, L Cornette
1Division of Paediatrics, University of Leeds, Leeds, UK.
Insights
A new scoring system accurately assesses brain development in premature infants. The Total Maturation Score (TMS) correlates with postmenstrual age and is reproducible for clinical MR reporting.
Area of Science:
- Neuroimaging
- Pediatric Radiology
- Developmental Neuroscience
Background:
- Assessing brain development in premature infants is crucial for clinical MR reporting.
- Quantitative data on cerebral maturation in preterm infants are limited.
- A novel scoring system, the Total Maturation Score (TMS), was developed to evaluate key developmental parameters.
Purpose of the Study:
- To validate a simple scoring system for assessing cerebral maturation in a large cohort of preterm infants.
- To establish the reliability and reproducibility of the Total Maturation Score (TMS).
- To correlate the TMS with postmenstrual age in premature infants.
Main Methods:
- Retrospective analysis of MR images from 134 preterm infants (23-41 weeks' gestational age).
- Exclusion of infants with early birth (<14 days prior to imaging) or suspected neuroabnormalities.
- Consensus derivation of the Total Maturation Score (TMS) and evaluation of interobserver agreement using Bland-Altman plots.
Main Results:
- The Total Maturation Score (TMS) showed a significant positive correlation with postmenstrual age.
- Mean TMS increased progressively with advancing postmenstrual age across evaluated groups.
- High interobserver agreement was achieved for the TMS (mean difference = 0.07, SD = 0.56).
Conclusions:
- The developed scoring system offers a standardized and reproducible method for evaluating cerebral maturation in premature infants.
- The Total Maturation Score (TMS) is easily calculable from standard MR images.
- This tool aids in detecting subtle neurodevelopmental changes within weeks of birth.
Background And Purpose:
The assessment of whether brain development is at an appropriate level for age has become an integral part of clinical MR reporting, although few studies have quantitatively defined the developmental changes occurring in premature infants. We have developed a simple scoring system to assess four parameters of cerebral maturation--myelination, cortical folding, glial cell migration, and germinal matrix distribution--to determine the total maturation score (TMS). The aim of this study was to validate this scoring system in a large population of preterm infants across a range of gestational ages.
Methods:
A retrospective analysis was conducted of MR images acquired over a 3-year period with an identical imaging protocol. Infants born more than 14 days before the imaging examination and those with a clinical or radiologic history suggestive of neuroabnormality were excluded from the study. The TMS was derived by consensus. Interobserver agreement was evaluated by using the Bland-Altman plot.
Results:
Images from 134 infants (23-41 weeks' gestational age) were evaluated. The TMS was significantly related to the postmenstrual age of the infant, with the mean TMS for each age group increasing with advancing postmenstrual age. Interobserver agreement was found to be high (mean difference in score = 0.07, SD = 0.56).
Conclusion:
This scoring system provides a standardized method for assessing cerebral maturation in the premature infant. The TMS is easy to calculate from standard MR images, is reproducible, and can help detect changes occurring within a postnatal age of a few weeks.
