Diffuse excessive high signal intensity on term equivalent MRI does not predict disability: a systematic review and...

Area of Science:

• Neonatal Neurology
• Neuroimaging
• Developmental Pediatrics

Background:

• Preterm infants are at high risk for neurodevelopmental disabilities.
• Term equivalent age MRI (TEA-MRI) is used to assess brain development in preterm infants.
• Diffuse excessive high signal intensity (DEHSI) is a finding on TEA-MRI that may indicate underlying brain injury.

Purpose of the Study:

• To systematically evaluate the diagnostic accuracy of DEHSI on TEA-MRI for predicting neurodevelopmental outcomes in preterm infants.
• To determine if DEHSI can predict cognitive/mental disabilities and cerebral palsy (CP).

Main Methods:

• Systematic review and meta-analysis of studies published up to July 2019.
• Inclusion of studies comparing developmental outcomes of isolated DEHSI on TEA-MRI versus normal TEA-MRI.
• Data extraction and risk of bias assessment by two independent reviewers.
• Meta-analysis performed on pooled data from eligible studies.

Main Results:

• Analysis included 15 studies (n=1832), with 9 contributing to meta-analysis.
• Pooled sensitivity and specificity for DEHSI predicting cognitive/mental disability were 0.58 and 0.46, respectively.
• Pooled sensitivity and specificity for DEHSI predicting cerebral palsy (CP) were 0.57 and 0.41, respectively.
• Low summary areas under the ROC curve (0.54 for cognitive disability, 0.51 for CP) and pooled DOR of 1 indicated poor diagnostic performance.

Conclusions:

• DEHSI on TEA-MRI is not a reliable predictor of future cognitive/mental disabilities in preterm infants.
• DEHSI on TEA-MRI does not accurately predict the development of cerebral palsy (CP) in this population.
• The findings suggest DEHSI should not be solely relied upon for prognostication of neurodevelopmental outcomes in preterm infants.