From the Department of Pediatric Newborn Medicine (E.S., H.M., M.E.-D., T.E.I.), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
First Department of Pediatrics (E.S.), Semmelweis University, Budapest, Hungary.
AJNR Am J Neuroradiol. 2021 May;42(5):969-974. doi: 10.3174/ajnr.A7048. Epub 2021 Mar 25.
MR imaging has a key role in predicting neurodevelopmental outcomes following neonatal hypoxic-ischemic encephalopathy (HIE). A novel MR imaging scoring system for hypoxic-ischemic brain injury was used in our patient population with the aim of assessing interobserver variability and developing subcategories for the severity of brain injury.
We evaluated brain MR images of 252 infants who underwent hypothermia for HIE between 2014 and 2019. First, 40 infants were selected randomly to test interobserver variability. Discrepancies were identified during the assessment of the first 20 MR images. The remaining 20 MR images were scored after adjusting the scoring system. Second, we determined cutoff values for the severity of injury that were based on the percentiles of the total scores in the full cohort.
The interobserver reliability showed excellent agreement for the total score both before (intraclass correlation coefficient = 0.96; 95% CI 0.89-0.99) and after the adjustment (intraclass correlation coefficient = 0.96; 95% CI, 0.89-0.98). The average of the differences and the agreement interval between the 2 readers decreased after the adjustment. Subcategories of brain injury were the following: We considered a total score of ≤4 (≤75%) as normal, 5-10 (76%-90%) as mild, 11-15 (91%-95%) as moderate, and >15 (>95%) as severe brain injury. The agreement on the classification of brain injury improved in the second epoch (weighted κ = 0.723 versus 0.887).
The adjusted scoring system may lead to a higher degree of interrater agreement. The presented cutoff values may be used to determine the severity of brain injury in future clinical studies including infants with mild hypoxia-ischemia.
磁共振成像（MR 成像）在预测新生儿缺氧缺血性脑病（HIE）后的神经发育结局方面发挥着关键作用。本研究采用一种新的缺氧缺血性脑损伤磁共振成像评分系统，旨在评估观察者间的变异性，并为脑损伤的严重程度制定亚类。
我们评估了 2014 年至 2019 年间 252 例接受 HIE 低温治疗的婴儿的脑 MR 图像。首先，随机选择 40 例婴儿来测试观察者间的变异性。在评估前 20 例 MR 图像时发现了差异。在调整评分系统后，对其余 20 例 MR 图像进行评分。其次，我们根据总分的百分位数确定损伤严重程度的截断值。
总评分的观察者间可靠性在调整前后均显示出极好的一致性（组内相关系数分别为 0.96；95%CI，0.89-0.99）。调整后，2 位观察者之间差异的平均值和一致性区间减小。脑损伤的亚类如下：我们将总分≤4（≤75%）定义为正常，5-10（76%-90%）为轻度，11-15（91%-95%）为中度，>15（>95%）为重度脑损伤。在第二阶段，脑损伤分类的一致性提高（加权κ=0.723 与 0.887）。
调整后的评分系统可能会导致更高程度的观察者间一致性。本研究提出的截断值可能用于确定未来包括轻度缺氧缺血在内的婴儿的脑损伤严重程度的临床研究。
