George J M, Fiori S, Fripp J, Pannek K, Bursle J, Moldrich R X, Guzzetta A, Coulthard A, Ware R S, Rose S E, Colditz P B, Boyd R N
From the Queensland Cerebral Palsy and Rehabilitation Research Centre (J.M.G., R.N.B.), Centre for Children's Health Research, Faculty of Medicine
Stella Maris Scientific Institute (S.F., A.G.), Department of Developmental Neuroscience, Pisa, Italy.
AJNR Am J Neuroradiol. 2017 Jul;38(7):1435-1442. doi: 10.3174/ajnr.A5191. Epub 2017 May 18.
The diagnostic and prognostic potential of brain MR imaging before term-equivalent age is limited until valid MR imaging scoring systems are available. This study aimed to validate an MR imaging scoring system of brain injury and impaired growth for use at 29 to 35 weeks postmenstrual age in infants born at <31 weeks gestational age.
Eighty-three infants in a prospective cohort study underwent early 3T MR imaging between 29 and 35 weeks' postmenstrual age (mean, 32 ± 1 weeks; 49 males, born at median gestation of 28 weeks; range, 23-30 weeks; mean birthweight, 1068 ± 312 g). Seventy-seven infants had a second MR scan at term-equivalent age (mean, 40 ± 1 weeks). Structural images were scored using a modified scoring system which generated WM, cortical gray matter, deep gray matter, cerebellar, and global scores. Outcome at 12-months corrected age (mean, 12 months 4 days ± 1 weeks) consisted of the Bayley Scales of Infant and Toddler Development, 3rd ed. (Bayley III), and the Neuro-Sensory Motor Developmental Assessment.
Early MR imaging global, WM, and deep gray matter scores were negatively associated with Bayley III motor (regression coefficient for global score β = -1.31; 95% CI, -2.39 to -0.23; = .02), cognitive (β = -1.52; 95% CI, -2.39 to -0.65; < .01) and the Neuro-Sensory Motor Developmental Assessment outcomes (β = -1.73; 95% CI, -3.19 to -0.28; = .02). Early MR imaging cerebellar scores were negatively associated with the Neuro-Sensory Motor Developmental Assessment (β = -5.99; 95% CI, -11.82 to -0.16; = .04). Results were reconfirmed at term-equivalent-age MR imaging.
This clinically accessible MR imaging scoring system is valid for use at 29 to 35 weeks postmenstrual age in infants born very preterm. It enables identification of infants at risk of adverse outcomes before the current standard of term-equivalent age.
在有效的磁共振成像（MR）评分系统出现之前，足月等效年龄之前脑磁共振成像的诊断和预后潜力有限。本研究旨在验证一种用于孕龄小于31周出生的婴儿在月经龄29至35周时的脑损伤和生长发育受损的MR成像评分系统。
一项前瞻性队列研究中的83名婴儿在月经龄29至35周（平均32±1周）时接受了早期3T MR成像检查（49名男性，中位孕龄28周出生；范围23 - 30周；平均出生体重1068±312克）。77名婴儿在足月等效年龄（平均40±1周）时进行了第二次MR扫描。使用改良评分系统对结构图像进行评分，该系统生成白质、皮质灰质、深部灰质、小脑和整体评分。校正年龄12个月（平均12个月4天±1周）时的结局包括贝利婴幼儿发展量表第3版（贝利III）和神经感觉运动发育评估。
早期MR成像的整体、白质和深部灰质评分与贝利III运动（整体评分的回归系数β = -1.31；95%可信区间，-2.39至 -0.23；P = 0.02）、认知（β = -1.52；95%可信区间，-2.39至 -0.65；P <0.01）以及神经感觉运动发育评估结局（β = -1.73；95%可信区间，-3.19至 -0.28；P = 0.02）呈负相关。早期MR成像的小脑评分与神经感觉运动发育评估呈负相关（β = -5.99；95%可信区间，-11.82至 -0.16；P = 0.04）。足月等效年龄MR成像时再次证实了这些结果。
这种临床可用的MR成像评分系统对于极早产出生的婴儿在月经龄29至35周时是有效的。它能够在目前足月等效年龄的标准之前识别出有不良结局风险的婴儿。
