Department of Neonatology, Emma Children's Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands,
Amsterdam Reproduction & Development Research Institute, Amsterdam University Medical Centers, Amsterdam, The Netherlands,
Neonatology. 2022;119(3):311-319. doi: 10.1159/000522629. Epub 2022 Mar 31.
The brain magnetic resonance imaging (MRI) result is a major predictor for the outcome of term infants with perinatal asphyxia who underwent therapeutic hypothermia. In daily practice, no uniform method is used to assess these images.
The aim of this study was to determine which MRI-score best predicts adverse outcome at 24 months of age and has the highest inter-rater reliability.
Four MRI scoring systems for term infants with perinatal asphyxia were selected: Rutherford score, Trivedi score, Weeke score, and NICHD NRN score. Experienced blinded raters retrospectively evaluated the brain MR Images of 161 infants using all four scoring systems. Long-term outcome (the composite outcome death or adverse outcome, and its separate components) were routinely assessed by standardized testing at the age of 24 months. The predictive accuracy was assessed by logistic regression analyses and expressed as area under the ROC curve (AUC). The inter-rater reliability of the scores was calculated by the weighted Kappa or intraclass correlation. A sensitivity analysis using only high-quality MRI scans was performed.
All four MRI scoring systems demonstrated an AUC of >0.66 for the prediction of adverse outcome and ≥0.80 for the prediction of death. The inter-rater reliability analyses demonstrated the highest reliability for the Weeke and Trivedi scores. When only assessing the high-quality scans, the AUC increased further.
All four MRI brain scores proved reliable predictors for an adverse outcome at 24 months of age. The Weeke and Trivedi score demonstrated the highest inter-rater reliability. The use of high-quality MRI further improved prediction.
脑磁共振成像（MRI）结果是接受治疗性低温治疗的足月围产期窒息婴儿结局的主要预测因素。在日常实践中，没有统一的方法来评估这些图像。
本研究旨在确定哪种 MRI 评分最能预测 24 个月时的不良结局，并且具有最高的组内可靠性。
选择了四种针对足月围产期窒息婴儿的 MRI 评分系统：Rutherford 评分、Trivedi 评分、Weeke 评分和 NICHD NRN 评分。有经验的盲法评分员使用所有四种评分系统对 161 名婴儿的脑部 MRI 图像进行了回顾性评估。长期结局（死亡或不良结局的复合结局及其单独成分）通过标准化测试在 24 个月龄时进行常规评估。通过逻辑回归分析评估预测准确性，并表示为 ROC 曲线下面积（AUC）。使用加权 Kappa 或组内相关系数计算评分的组内可靠性。还进行了仅使用高质量 MRI 扫描的敏感性分析。
所有四种 MRI 评分系统在预测不良结局时的 AUC 均>0.66，在预测死亡时的 AUC 均≥0.80。组内可靠性分析表明，Weeke 和 Trivedi 评分的可靠性最高。当仅评估高质量扫描时，AUC 进一步增加。
所有四种 MRI 脑评分均被证明是 24 个月时不良结局的可靠预测指标。Weeke 和 Trivedi 评分显示出最高的组内可靠性。使用高质量 MRI 进一步提高了预测能力。
