Department of Rehabilitation, Children's Hospital, Fudan University, Shanghai 201102, China.
Department of Radiology, Children's Hospital, Fudan University, Shanghai 201102, China.
Early Hum Dev. 2021 Dec;163:105452. doi: 10.1016/j.earlhumdev.2021.105452. Epub 2021 Aug 25.
To detect early brain structural and clinical functional markers of brain injury and development based on a magnetic resonance imaging (MRI) scoring system and a general movement assessment (GMA) for preterm infants later diagnosed with cerebral palsy (CP).
Retrospective cohort study. General movements (GMs) were scored according to a semiquantitative scoring system: the GMs optimality score (GMOS) at preterm and term ages and the Motor Optimality Score (MOS) at the corrected age of 3 months after birth. Brain magnetic resonance imaging (MRI) at term-equivalent age was scored using an MRI scoring system. We analyzed the relationship between the early degree of cerebral white matter (WM) abnormality and the GMOS and the MOS for infants born <32 weeks gestational age later diagnosed with CP in a comparison group of neurotypical controls.
Sixteen preterm infants were included in this study who underwent MRI and GMs assessment. 8 out of the 16 preterm infants were later diagnosed with CP, while the other 8 infants with normal motor development (N) were placed into the control group. Their median gestational age was 30w6d and 27w6d for each group respectively.
The cerebral WM MRI scores were significantly higher in the CP group than in the control group (p < 0.01). The GMOS and MOS were significantly higher in the control group than in the CP group (p < 0.05). The MOS showed a strong correlation to the cerebral WM MRI score (r = -0.88) and the subscale of cerebral WM items (the cystic degeneration and the focal signal abnormalities) of the MRI score (r = -0.94) in the CP group. The MOS also showed a correlation with corrected biparietal diameter (cBPD) in the preterm infant group with CP (r = 0.75). Results of linear regression analyses between term MRI and GMs measures in preterm infants with CP are presented. Cerebral WM scores were associated with the MOS (β = -0.63; 95%CI = -0.97, -0.29; p < 0.01). Cerebral WM injury, including the subscale of cystic degeneration and focal signal abnormalities was closely associated with the MOS (β = -0.83; 95%CI = -1.13, -0.54; p < 0.001).
Cerebral WM scores show a strong association with a decreased motor performance on the MOS in preterm infants later diagnosed with CP. Severe white matter injury and significantly decreased MOS scores may provide useful early markers and strong evidence to early predict the risk of later development of cerebral palsy in preterm infants.
基于磁共振成像 (MRI) 评分系统和一般运动评估 (GMA)，检测早产儿以后被诊断为脑瘫 (CP) 的脑损伤和发育的早期脑结构和临床功能标志物。
回顾性队列研究。根据半定量评分系统对一般运动 (GMs) 进行评分：早产儿和足月时的 GMs 最优评分 (GMOS)，以及出生后 3 个月时的运动最优评分 (MOS)。足月时进行脑 MRI (MRI) 评分，采用 MRI 评分系统。我们分析了出生胎龄 <32 周、以后被诊断为 CP 的婴儿的脑白质 (WM) 异常程度与 GMOS 和 MOS 之间的关系，与一组神经发育正常的对照组进行比较。
本研究纳入了 16 名接受 MRI 和 GMs 评估的早产儿。16 名早产儿中有 8 名以后被诊断为 CP，而其他 8 名运动发育正常 (N) 的婴儿则被纳入对照组。他们的中位胎龄分别为 30w6d 和 27w6d。
CP 组的脑 WM MRI 评分明显高于对照组 (p < 0.01)。CP 组 GMOS 和 MOS 评分明显高于对照组 (p < 0.05)。MOS 与 CP 组脑 WM MRI 评分 (r = -0.88) 和 MRI 评分的脑 WM 项目亚量表 (囊性变性和局灶性信号异常) (r = -0.94) 呈强相关性。MOS 与 CP 组早产儿的矫正双顶径 (cBPD) 也呈相关性 (r = 0.75)。呈现了 CP 组早产儿的脑 WM MRI 评分和 GMs 测量值之间的线性回归分析结果。脑 WM 评分与 MOS 相关 (β = -0.63; 95%CI = -0.97, -0.29; p < 0.01)。脑 WM 损伤，包括囊性变性和局灶性信号异常的亚量表，与 MOS 密切相关 (β = -0.83; 95%CI = -1.13, -0.54; p < 0.001)。
在以后被诊断为 CP 的早产儿中，脑 WM 评分与 MOS 上运动功能降低有很强的关联。严重的脑白质损伤和明显降低的 MOS 评分可能为早产儿以后发展为脑瘫的风险提供有用的早期标志物和有力证据。
