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MRI classification system (MRICS) for children with cerebral palsy: development, reliability, and recommendations
Kate Himmelmann1, Veronka Horber2, Javier De La Cruz3
1Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden.
Insights
A new MRI classification system for cerebral palsy (CP) in children, the MRI Classification System (MRICS), demonstrates good reliability for use in CP registers. This tool aids in consistent data collection for CP surveillance.
Area of Science:
- Neurology
- Pediatrics
- Radiology
Background:
- Cerebral palsy (CP) diagnosis relies on clinical assessment and neuroimaging.
- Standardized classification of MRI findings in children with CP is needed for accurate data in CP registers.
Purpose of the Study:
- To develop and evaluate a classification system for magnetic resonance imaging (MRI) findings in children with CP.
- To create a tool suitable for implementation in CP registers.
Main Methods:
- Developed the MRI Classification System (MRICS) based on pathogenic patterns across brain development stages.
- Created a detailed manual with test cases for MRICS.
- Assessed MRICS applicability and interrater reliability through an exercise with 41 professionals classifying MRIs or MRI reports.
Main Results:
- MRICS demonstrated good overall interrater reliability (k=0.69).
- Interrater reliability was very good when using MRI reports (k=0.81).
- Existing classification systems were found to be compatible with MRICS, allowing for harmonization.
Conclusions:
- The MRICS is proposed by the Surveillance of Cerebral Palsy in Europe (SCPE) as a reliable tool.
- The MRICS, with its manual, is simple to apply for CP registers, enhancing surveillance efforts.
Aim:
To develop and evaluate a classification system for magnetic resonance imaging (MRI) findings of children with cerebral palsy (CP) that can be used in CP registers.
Method:
The classification system was based on pathogenic patterns occurring in different periods of brain development. The MRI classification system (MRICS) consists of five main groups: maldevelopments, predominant white matter injury, predominant grey matter injury, miscellaneous, and normal findings. A detailed manual for the descriptions of these patterns was developed, including test cases (www.scpenetwork.eu/en/my-scpe/rtm/neuroimaging/cp-neuroimaging/). A literature review was performed and MRICS was compared with other classification systems. An exercise was carried out to check applicability and interrater reliability. Professionals working with children with CP or in CP registers were invited to participate in the exercise and chose to classify either 18 MRIs or MRI reports of children with CP.
Results:
Classification systems in the literature were compatible with MRICS and harmonization possible. Interrater reliability was found to be good overall (k=0.69; 0.54-0.82) among the 41 participants and very good (k=0.81; 0.74-0.92) using the classification based on imaging reports.
Interpretation:
Surveillance of Cerebral Palsy in Europe (SCPE) proposes the MRICS as a reliable tool. Together with its manual it is simple to apply for CP registers.
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