Verification of the ability of the new MRI classification system to predict neurodevelopmental outcome in very low-birth-weight infants
Masakazu Nishimoto1, Katsumi Hayakawa2, Koichi Tanda2
1Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kamigyo-ku, Kyoto 602-8566, Kyoto Prefecture, Japan.
Insights
This study evaluated a new MRI classification for white matter injury in very low-birth-weight infants. While the scoring tool
Area of Science:
- Neonatal neurology
- Neuroimaging
- Developmental pediatrics
Background:
- Very low-birth-weight infants (VLBWI) face significant risks for adverse neurodevelopmental outcomes.
- A novel classification system for white matter injury (WMI) in VLBWI has been proposed.
- Investigating WMI and neurodevelopmental outcomes using this new system is crucial.
Purpose of the Study:
- To assess the relationship between white matter injury grades and neurodevelopmental outcomes in VLBWI.
- To evaluate the utility of the Martinez-Biarge classification system for predicting outcomes.
- To determine the frequency of cerebral palsy and intellectual disability based on WMI severity.
Main Methods:
- A cohort of 131 VLBWI (birth weight <1500g) was analyzed.
- Brain MRI was performed at term-equivalent age and graded (0-IV) by two radiologists.
- Neurodevelopmental outcomes, including cerebral palsy (CP) and intellectual disability (ID), were assessed at ≥2 years.
Main Results:
- Most infants had Grade 0 WMI (87%).
- Grade I WMI was associated with an 18% CP frequency.
- All infants with Grade III or IV WMI experienced mild CP and intellectual disability.
Conclusions:
- The MRI scoring tool showed limited prognostic value overall.
- Severe WMI (Grade III and IV) strongly correlated with adverse neurodevelopmental outcomes (CP and ID).
- The classification system demonstrated excellent inter-rater reliability (kappa=0.95).
Background:
Very low-birth-weight infants (VLBWI) are at high risk for adverse neurodevelopmental outcomes. A new, feasible and practical classification system for white matter injury has been reported by Martinez-Biarge et al. Therefore, we investigated the relationship between white matter injury and neurodevelopmental outcomes using this system.
Materials And Methods:
We enrolled a consecutive series of VLBWI birth weights <1500 g between 2012 and 2015. Two radiologists evaluated the brain MRI obtained in the VLBWI at term-equivalent age. MRI findings were classified into six Grades (Grade 0, Ia, Ib, II, III, IV). The frequency of abnormalities in each Grade was examined. The neurodevelopmental outcome of the VLBWI was assessed at two years or older, and we investigated the presence of cerebral palsy (CP) and intellectual disability (ID), and other serious outcomes. We also calculated the simple kappa value before the raters were matched.
Results:
Among 167 VLBWI, 131 met the eligibility criteria. 114 was Grade 0 (87%), 11 was Grade I (8.4%), 3 was Grade II (2.3%), 1 was Grade III (0.8%), and 2 was Grade IV (1.5%). The frequency of any abnormalities of intelligence in Grade 0 was 24%. The frequency of CP in Grade I was 18%. All Grade III and Grade IV cases had mild CP and an ID. The simple kappa value was 0.95.
Conclusion:
The prognostic value of the MRI scoring tool was limited. However, all Grade III and Grade IV cases had mild CP and ID. The results demonstrated an excellent inter-rater correlation.
