Automated brain morphometric biomarkers from MRI at term predict motor development in very preterm infants
Julia E Kline1, Venkata Sita Priyanka Illapani1, Lili He2
1Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
Insights
Brain imaging at term-equivalent age can predict motor development in very preterm infants. Objective brain morphometrics, including thalamic volume and cortical curvature, show promise for early risk identification.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Medical Imaging
Background:
- Very preterm infants (gestational age ≤31 weeks) face high risks of motor impairments.
- Early identification of high-risk infants is crucial for effective intervention, but current biomarkers lack accuracy.
- Objective biomarkers are needed for early risk-stratification in this vulnerable population.
Purpose of the Study:
- To investigate the predictive value of objective brain morphometric biomarkers derived from structural MRI for motor development in very preterm infants.
- To identify specific brain structural features that can predict motor outcomes at two years corrected age.
- To assess if these brain biomarkers provide independent predictive value beyond known risk factors.
Main Methods:
- Prospective enrollment of 75 very preterm infants from level-III NICUs.
- Structural brain MRI at term-equivalent age, with automated derivation of brain volumetrics and cortical morphometrics (surface area, sulcal depth, gyrification index, curvature).
- Correlation of MRI-derived measures with Bayley-III motor scores (overall, gross, fine) at two years corrected age, using Lasso and multivariable regression.
Main Results:
- Positive associations were found between motor scores and regional cortical surface area and subcortical volumes.
- Negative associations were observed between motor scores and cortical curvature across most brain regions.
- Thalamic volume, temporal lobe curvature, and insula curvature significantly predicted overall motor development, independent of other factors.
Conclusions:
- Objective brain morphometric biomarkers obtained via MRI at term-equivalent age hold promise for predicting motor development in very preterm infants.
- Specific measures like thalamic volume and regional cortical curvature are valuable predictors.
- These findings support the potential use of advanced neuroimaging for early risk assessment and targeted interventions.
Abstract:
Very preterm infants are at high risk for motor impairments. Early interventions can improve outcomes in this cohort, but they would be most effective if clinicians could accurately identify the highest-risk infants early. A number of biomarkers for motor development exist, but currently none are sufficiently accurate for early risk-stratification. We prospectively enrolled very preterm (gestational age ≤31 weeks) infants from four level-III NICUs. Structural brain MRI was performed at term-equivalent age. We used a established pipeline to automatically derive brain volumetrics and cortical morphometrics - cortical surface area, sulcal depth, gyrification index, and inner cortical curvature - from structural MRI. We related these objective measures to Bayley-III motor scores (overall, gross, and fine) at two-years corrected age. Lasso regression identified the three best predictive biomarkers for each motor scale from our initial feature set. In multivariable regression, we assessed the independent value of these brain biomarkers, over-and-above known predictors of motor development, to predict motor scores. 75 very preterm infants had high-quality T2-weighted MRI and completed Bayley-III motor testing. All three motor scores were positively associated with regional cortical surface area and subcortical volumes and negatively associated with cortical curvature throughout the majority of brain regions. In multivariable regression modeling, thalamic volume, curvature of the temporal lobe, and curvature of the insula were significant predictors of overall motor development on the Bayley-III, independent of known predictors. Objective brain morphometric biomarkers at term show promise in predicting motor development in very preterm infants.
