Diagnostic accuracy of neonatal structural MRI scores to predict 6-year motor outcomes of children born very preterm

Karen H Mistry; Samudragupta Bora; Kerstin Pannek; Alex M Pagnozzi; Simona Fiori; Andrea Guzzetta; Robert S Ware; Paul B Colditz; Roslyn N Boyd; Joanne M George

doi:10.1016/j.nicl.2024.103725

Diagnostic accuracy of neonatal structural MRI scores to predict 6-year motor outcomes of children born very preterm

Neuroimage Clin. 2024 Dec 14:45:103725. doi: 10.1016/j.nicl.2024.103725. Online ahead of print.

Authors

Affiliations

¹ Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia. Electronic address: [email protected].
² Mater Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, Australia; Health Services Research Center, University Hospitals Research & Education Institute, Department of Pediatrics, University Hospitals Rainbow Babies & Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, USA.
³ The Australian e-Health Research Centre, CSIRO Health and Biosecurity, Brisbane, Australia; School of Electrical Engineering and Computer Science, The University of Queensland, Brisbane, Australia.
⁴ The Australian e-Health Research Centre, CSIRO Health and Biosecurity, Brisbane, Australia.
⁵ Neuroscience and Medical Genetics Department, Meyer Children's Hospital, Florence, Italy; Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy.
⁶ Department of Developmental Neuroscience, IRCCS Stella Maris Foundation, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
⁷ Griffith Biostatistics Unit, Griffith University, Brisbane, Australia.
⁸ The University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia; Perinatal Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia.
⁹ Queensland Cerebral Palsy and Rehabilitation Research Centre (QCPRRC), Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
¹⁰ Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia; Physiotherapy Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Australia.

PMID: 39700899
DOI: 10.1016/j.nicl.2024.103725

Abstract

Aims: This study aimed to (1) evaluate associations between Early and Term structural MRI (sMRI) brain abnormality scores and adverse motor outcomes at 6-years corrected age (CA), (2) determine their diagnostic accuracy in predicting adverse motor outcomes and cerebral palsy (CP) at 6-years CA.

Methods: Infants born < 31-weeks gestational age (GA) returning for 6-year follow-up were included. Early and Term sMRI were scored using a validated method, deriving white matter, cortical grey matter, deep grey matter, cerebellar and global brain abnormality scores (GBAS). At 6-years CA, Movement Assessment Battery for Children-2nd Edition (MABC-2) was administered. Linear regression assessed associations between Early and Term GBAS/subscale scores and 6-year MABC-2 total score. For diagnostic accuracy, sMRI scores were categorised as none/mild vs moderate/severe, MABC-2 cut-off ≤ 5th percentile, and CP as present/absent.

Results: Infants had Early MRI (n = 123) at mean PMA 32.5-weeks (median GA 28.4-weeks; mean birthweight 1101 g) and n = 114 had Term MRI (Mean PMA 40.8-weeks). Nine had CP and n = 116 had MABC-2 scores. Early (B: -1.92; p ≤ 0.001) and Term (B: -1.67; p ≤ 0.01) GBAS were negatively associated with MABC-2 scores. Both Early and Term GBAS had high specificity (Sp) and low sensitivity (Se) in predicting MABC-2 ≤ 5th percentile (Early: Se 36 %, Sp 82 %; Term: Se 28 %, Sp 93 %) and predicted CP with high Se and Sp (Early: Se 78 %, Sp 78 %; Term: Se 75 %, Sp 89 %).

Conclusion: High Sp of Early and Term MRI predicting an outcome on MABC-2 may help accurately identify infants unlikely to develop motor impairments at 6-years CA.

Keywords: Cerebral palsy; Diagnostic accuracy; MABC-2; Motor outcome; Structural MRI; Very preterm.