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Published on: February 18, 2012
MRI Findings at Term-Corrected Age and Neurodevelopmental Outcomes in a Large Cohort of Very Preterm Infants
S Arulkumaran1, N Tusor2, A Chew2
1From the Centre for the Developing Brain (S.A., N.T., A.C., S.F., J.V.H., S.J.C., M.A.R., A.D.E.), School of Biomedical engineering and Imaging Sciences, King's College London and Evelina London Children's Hospital, London, UK sg-baker@doctors.org.uk.
Insights
Brain MR imaging at term-equivalent age is valuable for assessing preterm infant brain injury. While common, acquired brain lesions do not always predict poor neurodevelopmental outcomes at 20 months.
Area of Science:
- Neonatal neurology
- Pediatric radiology
- Neurodevelopmental outcomes
Background:
- Brain Magnetic Resonance (MR) imaging at term-equivalent age is crucial for identifying brain injuries in preterm infants.
- A large, unselected cohort of preterm infants underwent imaging to assess the spectrum and frequency of acquired brain lesions and their impact on outcomes.
Purpose of the Study:
- To pragmatically assess brain MR imaging findings in preterm infants at term-equivalent age.
- To determine the relationship between acquired brain lesions and neurodevelopmental outcomes at 20 months corrected age.
- To evaluate the sensitivity, specificity, and predictive values of MR imaging findings for various developmental outcomes.
Main Methods:
- Recruitment of infants born before 33 weeks' gestation from London neonatal units.
- 3 Tesla (3T) MR imaging performed at term-equivalent age.
- Neurodevelopmental assessment at 20 months corrected age, including motor, cognitive, and language evaluations.
- Qualitative assessment of corpus callosal thinning and ventricular dilation.
Main Results:
- 504 infants underwent MR imaging; 477 attended follow-up.
- 76% of infants exhibited acquired brain lesions, including periventricular leukomalacia, hemorrhagic infarction, and intraventricular hemorrhage.
- Periventricular leukomalacia was associated with abnormal motor outcomes in all cases; hemorrhagic infarction in 60% of cases.
- MR imaging without focal lesions showed 45% sensitivity and 61% specificity for normal neurodevelopment, and 17% sensitivity and 94% specificity for normal motor outcome.
Conclusions:
- Acquired brain lesions are frequent in preterm infants imaged at term-equivalent age.
- The presence of lesions does not invariably predict adverse neurodevelopmental outcomes.
- Routine MR imaging is a valuable tool, but interpretation requires consideration of its predictive limitations for specific outcomes.
Background And Purpose:
Brain MR imaging at term-equivalent age is a useful tool to define brain injury in preterm infants. We report pragmatic clinical radiological assessment of images from a large unselected cohort of preterm infants imaged at term and document the spectrum and frequency of acquired brain lesions and their relation to outcomes at 20 months.
Materials And Methods:
Infants born at <33 weeks' gestation were recruited from South and North West London neonatal units and imaged in a single center at 3T at term-equivalent age. At 20 months' corrected age, they were invited for neurodevelopmental assessment. The frequency of acquired brain lesions and the sensitivity, specificity, and negative and positive predictive values for motor, cognitive, and language outcomes were calculated, and corpus callosal thinning and ventricular dilation were qualitatively assessed.
Results:
Five hundred four infants underwent 3T MR imaging at term-equivalent age; 477 attended for assessment. Seventy-six percent of infants had acquired lesions, which included periventricular leukomalacia, hemorrhagic parenchymal infarction, germinal matrix-intraventricular hemorrhage, punctate white matter lesions, cerebellar hemorrhage, and subependymal cysts. All infants with periventricular leukomalacia, and 60% of those with hemorrhagic parenchymal infarction had abnormal motor outcomes. Routine 3T MR imaging of the brain at term-equivalent age in an unselected preterm population that demonstrates no focal lesion is 45% sensitive and 61% specific for normal neurodevelopment at 20 months and 17% sensitive and 94% specific for a normal motor outcome.
Conclusions:
Acquired brain lesions are common in preterm infants routinely imaged at term-equivalent age, but not all predict an adverse neurodevelopmental outcome.
