Related Experiment Video
Updated: Jun 28, 2025
Early Pathological and Magnetic Resonance Detection of Cerebral Injury Using a Rat Model of Neonatal Hypoxic Ischemic Encephalopathy
Published on: October 28, 2022
The predictive value of MRI scores for neurodevelopmental outcome in infants with neonatal encephalopathy
Csilla Andorka1, Hajnalka Barta1, Timea Sesztak1,2
1Division of Neonatology, Pediatric Center, MTA Center of Excellence, Semmelweis University, Budapest, Hungary.
Background:
MRI scoring systems are utilized to quantify brain injury and predict outcome in infants with neonatal encephalopathy (NE). Our aim was to evaluate the predictive accuracy of total scores, white matter (WM) and grey matter (GM) subscores of Barkovich and Weeke scoring systems for neurodevelopmental outcome at 2 years of age in infants receiving therapeutic hypothermia for NE.
Methods:
Data of 162 infants were analyzed in this retrospective cohort study. DeLong tests were used to compare areas under the curve of corresponding items of the two scoring systems. LASSO logistic regression was carried out to evaluate the association between MRI scores and adverse composite (death or severe disabilities), motor and cognitive outcomes (Bayley developmental index <70).
Results:
Weeke scores predicted each outcome measure with greater accuracy than the corresponding items of Barkovich system (DeLong tests p < 0.03). Total scores, GM and cerebellum involvement were associated with increased odds for adverse outcomes, in contrast to WM injury, after adjustment to 5' Apgar score, first postnatal lactate and aEEG normalization within 48 h.
Conclusion:
A more detailed scoring system had better predictive value for adverse outcome. GM injury graded on both scoring systems was an independent predictor of each outcome measure.
Impact Statements:
A more detailed MRI scoring system had a better predictive value for motor, cognitive and composite outcomes. While hypoxic-ischemic brain injuries in the deep grey matter and cerebellum were predictive of adverse outcome, white matter injury including cortical involvement was not associated with any of the outcome measures at 2 years of age. Structured MRI evaluation based on validated scores may aid future clinical research, as well as inform parents and caregivers to optimize care beyond the neonatal period.
Insights
The Weeke MRI scoring system better predicts neurodevelopmental outcomes in infants with neonatal encephalopathy (NE) than the Barkovich system. Grey matter injury, not white matter injury, independently predicts adverse outcomes.
Area of Science:
- Neonatal Neurology
- Neuroimaging
- Developmental Pediatrics
Background:
- MRI scoring systems are crucial for assessing brain injury and predicting outcomes in infants with neonatal encephalopathy (NE).
- Evaluating the predictive accuracy of existing MRI scoring systems is essential for refining prognostic capabilities.
Purpose of the Study:
- To compare the predictive accuracy of the Barkovich and Weeke MRI scoring systems for neurodevelopmental outcomes at 2 years of age in infants treated with therapeutic hypothermia for NE.
- To determine the independent predictive value of white matter (WM) and grey matter (GM) subscores for adverse outcomes.
Main Methods:
- Retrospective cohort study of 162 infants receiving therapeutic hypothermia for NE.
- Comparison of areas under the curve for Barkovich and Weeke scoring systems using DeLong tests.
- LASSO logistic regression to assess the association between MRI scores and composite, motor, and cognitive outcomes.
Main Results:
- The Weeke scoring system demonstrated higher predictive accuracy than the Barkovich system for all outcome measures (p < 0.03).
- Total scores, GM, and cerebellum involvement were associated with increased odds of adverse outcomes.
- White matter (WM) injury was not significantly associated with adverse outcomes after adjusting for clinical factors.
Conclusions:
- More detailed MRI scoring systems offer superior predictive value for neurodevelopmental outcomes in NE.
- Grey matter (GM) injury is an independent predictor of adverse motor, cognitive, and composite outcomes.
- Structured MRI evaluation using validated scores can inform clinical research and parental counseling.
