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Synthetic magnetic resonance-based relaxometry and brain volume: cutoff values for predicting neurocognitive outcomes
Tim Vanderhasselt1, Maarten Naeyaert2, Nico Buls2
1Department of Radiology, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium. tim.vanderhasselt@gmail.com.
Insights
Quantitative synthetic MRI measures, specifically T1 relaxation time and brain volume, show promise in predicting neurodevelopmental impairment in very preterm infants, aiding early clinical decisions.
Area of Science:
- Neonatal neurology
- Medical imaging
- Developmental pediatrics
Background:
- Early neurorehabilitation improves outcomes in very preterm infants, but conventional MRI has limited predictive value for neurodevelopmental delay.
- There is a need for timely, quantitative biomarkers to identify infants at risk of neurodevelopmental delay.
Purpose of the Study:
- To evaluate quantitative synthetic MRI measurements at term-equivalent age as predictive biomarkers for neurodevelopmental impairment.
- To establish practical cutoff values for synthetic MRI metrics to guide clinical decision-making in very preterm infants.
Main Methods:
- Retrospective study of 93 very preterm infants (born <32 weeks gestation).
- Synthetic MRI was performed at term-equivalent age; neurodevelopment was assessed using the Bayley-III scale at a mean age of 2.1 years.
- Receiver operating characteristic (ROC) curve analysis was used to determine the predictive value of synthetic MRI volumetry and T1/T2 relaxation measurements.
Main Results:
- T1 relaxation time in the posterior limb of the internal capsule strongly predicted severe (AUC, 0.91) and any (mild/severe) developmental impairment (AUC, 0.75).
- T2 relaxation time and brain parenchymal volume also predicted severe impairment (AUCs, 0.76 and 0.72, respectively), outperforming qualitative MRI scores (AUC, 0.66).
Conclusions:
- Quantitative synthetic MRI metrics, including T1 relaxation time and brain volume, show potential as reliable predictors of neurodevelopmental impairment in very preterm infants.
- Proposed cutoff values derived from synthetic MRI can aid in the early identification and management of infants at risk for neurodevelopmental delay.
Background:
Early neurorehabilitation can enhance neurocognitive outcomes in very preterm infants (<32 weeks), and conventional magnetic resonance imaging (MRI) is commonly used to assess neonatal brain injury; however, the predictive value for neurodevelopmental delay is limited. Timely predictive quantitative biomarkers are needed to improve early identification and management of infants at risk of neurodevelopmental delay.
Objective:
To evaluate the potential of quantitative synthetic MRI measurements at term-equivalent age as predictive biomarkers of neurodevelopmental impairment and establish practical cutoff values to guide clinical decision-making.
Materials And Methods:
This retrospective study included 93 very preterm infants who underwent synthetic MRI at term-equivalent age between January 2017 and September 2020. Clinical outcomes were assessed using the Bayley-III scale of infant development (mean age 2.1 years). The predictive value for impaired development was analyzed using receiver operating characteristic curves for synthetic MRI-based volumetry and T1 and T2 relaxation measurements.
Results:
The T1 relaxation time in the posterior limb of the internal capsule was a potent predictor of severe (sensitivity, 92%; specificity, 80%; area under the curve (AUC), 0.91) and mild or severe (AUC, 0.75) developmental impairment. T2 relaxation time in the posterior limb of the internal capsule was a significant predictor of severe impairment (AUC, 0.76), whereas the brain parenchymal volume was a significant predictor of severe (AUC, 0.72) and mild or severe impairment (AUC, 0.71) outperforming the reported qualitative MRI scores (AUC, 0.66).
Conclusion:
The proposed cutoff values for T1 relaxation time in the posterior limb of the internal capsule and for total brain volume measurements, derived from synthetic MRI, show promise as predictors of both mild and severe neurodevelopmental impairment in very preterm infants.
