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Early brain morphometrics from neonatal MRI predict motor and cognitive outcomes at 2-years corrected age in very
Alex M Pagnozzi1, Liza van Eijk2, Kerstin Pannek1
1CSIRO Health and Biosecurity, The Australian e-Health Research Centre, Royal Brisbane and Women's Hospital, Herston, Brisbane, QLD 4029, Australia.
Insights
Early brain Magnetic Resonance Imaging (MRI) in very preterm infants can predict neurodevelopmental outcomes. This allows for timely interventions to improve cognitive and motor development in high-risk infants.
Area of Science:
- Neuroscience
- Developmental Pediatrics
- Radiology
Background:
- Infants born very preterm often experience neurodevelopmental challenges affecting cognition, language, behavior, and motor skills.
- Early identification of at-risk infants through clinical assessment and Magnetic Resonance Imaging (MRI) is crucial for prognostication and initiating timely interventions.
Purpose of the Study:
- To identify early Magnetic Resonance Imaging (MRI) biomarkers for predicting neurodevelopmental outcomes in infants born very preterm.
- To assess the utility of neonatal MRI for early intervention planning.
Main Methods:
- A prospective cohort of 181 infants born before 31 weeks gestation underwent 3T MRI scans between 29-35 weeks postmenstrual age.
- Neurodevelopmental evaluation at 2 years corrected age included Bayley Scales of Infant and Toddler Development - Third Edition and Neuro-sensory Motor Developmental Assessment.
- Advanced structural MRI pre-processing and the developing Human Connectome Pipeline were used, with Least Absolute Shrinkage and Selection Operator (LASSO) regression for analysis.
Main Results:
- Significant associations were found between early MRI brain structure and 2-year motor (r=0.51) and cognitive (r=0.48) outcomes.
- Key MRI biomarkers identified include cortical grey matter volumes, cortical thickness, and sulcal depth.
- Adverse motor and cognitive outcomes were accurately predicted with an Area Under the Curve of 0.86.
Conclusions:
- Early neonatal MRI measures are associated with 2-year neurodevelopmental outcomes and patient prognosis.
- Neonatal MRI is a valuable tool for predicting outcomes and enabling earlier targeted interventions for very preterm infants.
Abstract:
Infants born very preterm face a range of neurodevelopmental challenges in cognitive, language, behavioural and/or motor domains. Early accurate identification of those at risk of adverse neurodevelopmental outcomes, through clinical assessment and Magnetic Resonance Imaging (MRI), enables prognostication of outcomes and the initiation of targeted early interventions. This study utilises a prospective cohort of 181 infants born <31 weeks gestation, who had 3T MRIs acquired at 29-35 weeks postmenstrual age and a comprehensive neurodevelopmental evaluation at 2 years corrected age (CA). Cognitive, language and motor outcomes were assessed using the Bayley Scales of Infant and Toddler Development - Third Edition and functional motor outcomes using the Neuro-sensory Motor Developmental Assessment. By leveraging advanced structural MRI pre-processing steps to standardise the data, and the state-of-the-art developing Human Connectome Pipeline, early MRI biomarkers of neurodevelopmental outcomes were identified. Using Least Absolute Shrinkage and Selection Operator (LASSO) regression, significant associations between brain structure on early MRIs with 2-year outcomes were obtained (r = 0.51 and 0.48 for motor and cognitive outcomes respectively) on an independent 25% of the data. Additionally, important brain biomarkers from early MRIs were identified, including cortical grey matter volumes, as well as cortical thickness and sulcal depth across the entire cortex. Adverse outcome on the Bayley-III motor and cognitive composite scores were accurately predicted, with an Area Under the Curve of 0.86 for both scores. These associations between 2-year outcomes and patient prognosis and early neonatal MRI measures demonstrate the utility of imaging prior to term equivalent age for providing earlier commencement of targeted interventions for infants born preterm.
