Abstract
Purpose: The aim of this study was to correlate hypoxic-ischemic white matter damage on neonatal MRI with MRI appearance and neurological outcome at the age of 1œ years. Patients and Methods: A sequential cohort of infants with periventricular densities on neonatal ultrasound was studied with neonatal MRI. Images of 46 infants with a mean gestational age of 31 weeks were obtained at a mean age of 20 days after birth and at 1œ years. To establish agreement between the neonatal and follow-up MRI (general, motor, and visual scores), the weighted Cohen's kappa test was used. To establish the predictive power of neonatal MRI with respect to the neurologic indices at the age of 1œ years, the sensitivity, specificity, and positive and negative predictive values were calculated. Results: There was a moderately good to good agreement between the general, motor, and visual neonatal and follow-up MRI scores: weighted kappa = 0.59 (95 % CI: 0.44 - 0.74), 0.82 (95 % CI: 0.72 - 0.93), and 0.70 (95 % CI: 0.56 - 0.84), respectively. Neonatal MRI scores provided a good prediction of the three neurological outcome measures (developmental delay, cerebral palsy, and cerebral visual impairment): sensitivity, specificity, and predictive values were high, with little difference between the three MRI scores. The 32 patients with (nearly) normal neonatal MRI scores were neurologically (nearly) normal at 1œ years on all three outcome measures, whereas 8 patients with seriously abnormal neonatal MRI scores were neurologically abnormal at 1œ years on all three outcome measures. Conclusion: Neonatal MRI is able to predict the precise localization and size of perinatal leukomalacia on follow-up MRI and provides a good prediction of neurological outcome at 1œ years.
Key words
MRI - periventricular echo densities - periventricular leukomalacia - infants - neurological outcome
References
1
Aida N, Nishimura G, Hachiya Y, Matsui K, Takeuchi M, Itani Y.
MR imaging of perinatal brain damage: comparison of clinical outcome with initial and follow-up MR findings.
AJNR.
1998;
19
1909-1921
2
Amiel-Tison C, Ellison P.
Birth asphyxia in the fullterm newborn: early assessment and outcome.
Dev Med Child Neurol.
1986;
28
671-682
3
Anonymous.
An international classification of retinopathy of prematurity. Prepared by an international committee.
Brit J Ophthalmol.
1984;
68
690-697
4
Armstrong D, Norman M G.
Periventricular leucomalacia in neonates. Complications and sequelae.
Arch Dis Child.
1974;
49
367-375
5
Baenziger O, Martin E, Steinlin M, Good M, Largo R, Burger R. et al .
Early pattern recognition in severe perinatal asphyxia: a prospective MRI study.
Neuroradiology.
1993;
35
437-442
6
Barkovich A J.
MR and CT evaluation of profound neonatal and infantile asphyxia.
AJNR.
1992;
13
959-972
7 Barkovich A J. Normal development of the neonatal and infant brain, skull, and spine. Barkovich AJ Pediatric Neuroimaging. 3rd ed. Philadelphia; Lippincott, Williams & Wilkins 2000: 13-69
8
Battin M R, Maalouf E F, Counsel S J, Herlihy A H, Rutherford M A, Azzopardi D. et al .
Magnetic resonance imaging of the brain in very preterm infants: visualization of the germinal matrix, early myelination, and cortical folding.
Pediatrics.
1998;
101
957-962
9
Byrne P, Welch R, Johnson M A, Darrah J, Piper M.
Serial magnetic resonance imaging in neonatal hypoxic-ischemic encephalopathy.
J Pediatr.
1990;
117
694-700
10
Cioni G, Bartalena L, Biagioni E, Boldrini A, Canapicchi R.
Neuroimaging and functional outcome of neonatal leukomalacia.
Behav Brain Res.
1992;
49
7-19
11
Cioni G, Bertuccelli B, Boldrini A. et al .
Correlation between visual function, neurodevelopmental outcome, and magnetic resonance imaging findings in infants with periventricular leukomalacia.
Arch Dis Child Fetal Neonatal Ed.
2000;
82
F134-F140
12
Cornette L G, Tanner S F, Ramenghi L A, Miall L S, Childs A M, Arthur R J. et al .
Magnetic resonance imaging of the infant brain: anatomical characteristics and clinical significance of puntate lesions.
Arch Dis Child Fetal Neonatal Ed.
2002;
86
F171-F177
13
De Groot L, Hopkins B, Touwen B CL.
A method to assess the development of muscle power in preterms after term age.
Neuropediatrics.
1992;
23
172-179
14
De Vries L S, Eken P, Dubowitz L MS.
The spectrum of leukomalacia using cranial ultrasound.
Behav Brain Res.
1992;
49
1-6
15
Eken P, De Vries L S, Van der Graaf Y, Meiners L C, Van Nieuwenhuizen O.
Haemorrhagic-ischaemic lesions of the neonatal brain: correlation between cerebral visual impairment, neurodevelopmental outcome and MRI in infancy.
Dev Med Child Neurol.
1995;
37
41-55
16
Fawer C L, Calame A, Perentes E, Anderegg A.
Periventricular leucomalacia: A correlation study between real-time ultrasound and autopsy findings.
Neuroradiology.
1985;
27
292-300
17
Felderhoff-Mueser U, Rutherford M A, Squier W V, Cox P, Maalouf E F, Counsell S J. et al .
Relationship between MR imaging and histopathologic findings of the brain in extremely sick preterm infants.
AJNR.
1999;
20
1349-1357
18
Flodmark O, Lupton B, Li D, Stimac G K, Roland E H, Hill A. et al .
MR imaging of periventricular leukomalacia in childhood.
Am J Roentgenol.
1989;
152
583-590
19
Gibson N A, Fielder A R, Trounce J Q, Levene M I.
Ophthalmic findings in infants of very low birthweight.
Dev Med Child Neurol.
1990;
32
7-13
20
Hagberg B, Hagberg G, Olow I.
The changing panorama of cerebral palsy in Sweden. I. Analysis of general changes.
Acta Paediatr Scand.
1975;
64
187-192
21
Ipata A E, Cioni G, Bottai P, Fazzi B, Canapicchi R, Van Hof-Van Duin J.
Acuity card testing in children with cerebral palsy related to magnetic resonance images, mental levels and motor abilities.
Brain Dev.
1994;
16
195-203
22
Keeney S E, Adcock E W, Mc Ardle C B.
Prospective observations of 100 high-risk neonates by high-field (1.5 Tesla) magnetic resonance imaging of the central nervous system, I: intraventricular and extracerebral lesions.
Pediatrics.
1991;
87
421-430
23
Koeda T, Takeshita K.
Visuo-perceptual impairment and cerebral lesions in spastic diplegia with preterm birth.
Brain Dev.
1992;
14
239-244
24
Krägeloh-Mann I, Toft P, Lunding J, Andresen J, Pryds O, Lou H C.
Brain lesions in preterms: origin, consequence and compensation.
Acta Paediatr.
1999;
88
897-908
25
Lanzi G, Fazzi E, Uggetti C, Cavallini A, Danova S, Egitto M G. et al .
Cerebral visual impairment in periventricular leukomalacia.
Neuropediatrics.
1998;
29
145-150
26
Ment L R, Bada H S, Barnes P, Grant P E, Hirtz D, Papile L A. et al .
Practice parameter: neuroimaging of the neonate. Report of the quality standards subcommittee of the American Academy of Neurology and the practice committee of the Child Neurology Society.
Neurology.
2002;
58
1726-1738
27
Panneth N, Rudelli R, Monte W, Rodriguez E, Pinto J, Kairam R. et al .
White matter necrosis in very low birth weight infants: neuropathologic and ultrasonographic findings in infants surviving six days or longer.
J Pediatr.
1990;
116
975-984
28
Pike M G, Holmstrom G, De Vries L S, Pennock J M, Drew K J, Sonksen P M. et al .
Patterns of visual impairment associated with lesions of the preterm infant brain.
Dev Med Child Neurol.
1994;
36
849-862
29
Roelants-Van Rijn A M, Groenendaal F, Beek F JA, Eken P, Van Haastert I C, De Vries L S.
Parenchymal brain injury in the preterm infant: comparison of cranial ultrasound, MRI and neurodevelopmental outcome.
Neuropediatrics.
2001;
32
80-89
30
Rutherford M A, Pennock J M, Dubowitz L MS.
Cranial ultrasound and magnetic resonance imaging in hypoxic-ischemic encephalopathy: a comparison with outcome.
Dev Med Child Neurol.
1994;
36
813-825
31
Rutherford M A, Pennock J, Schwieso J, Cowan F, Dubowitz L MS.
Hypoxic-ischaemic encephalopathy: early and late magnetic resonance imaging findings in relation to outcome.
Arch Dis Child.
1996;
75
F145-F151
32
Sie L TL, Van der Knaap M S, Van Wezel-Meijler G, Valk J.
MRI assessment of myelination of motor and sensory pathways in the brain of preterm and term-born infants.
Neuropediatrics.
1997;
28
97-105
33
Sie L TL, Van der Knaap M S, Van Wezel-Meijler G, Taets van Amerongen A HM, Lafeber H N, Valk J.
Early MR features of hypoxic-ischemic brain injury in neonates with periventricular densities on sonograms.
AJNR.
2000;
21
852-861
34
Sie L TL, Barkhof F, Lafeber H N, Valk J, Van der Knaap M S.
Value of fluid-attenuated inversion recovery sequences in early MRI of the brain in neonates with a perinatal hypoxic-ischemic encephalopathy.
Eur Radiol.
2000;
10
1594-1601
35
Sobel D F, Gallen C C, Schwartz B J, Waltz T A, Copeland B, Yamada S. et al .
Locating the central sulcus: comparison of MR, anatomic and magnetoencephalographic functional methods.
AJNR.
1993;
14
915-925
36
Teller D Y, McDonald M A, Preston K, Sebris S L, Dobson V.
Assessment of visual acuity in infants and children: the acuity card procedure.
Dev Med Child Neurol.
1986;
28
779-789
37 Touwen B CL. Examination of the child with minor neurological dysfunction. Clinics in Developmental Medicine. No. 71. London; Heinemann 1979
38
Uggetti C, Egitto M G, Fazzi E, Bianchi P E, Bergamaschi R, Zappoli F. et al .
Cerebral visual impairment in periventricular leukomalacia: MR correlation.
AJNR.
1996;
17
979-985
39
Van der Knaap M S, Valk J.
MR imaging of various stages of normal myelination during the first year of life.
Neuroradiology.
1990;
31
459-470
40 Van der Meulen B F, Smrkovsky M. B.O.S. 2 - 30. Bayley ontwikkelingsschalen. Handleiding. Lisse; Swets & Zeitlinger 1983
41
Van Hof-van Duin J, Heersema D J, Groenendaal F, Baerts W, Fetter W P.
Visual field and grating acuity development in low-risk preterm infants during the first 2œ years after term.
Behav Brain Res.
1992;
49
115-122
42 Van Nieuwenhuizen O. Cerebral visual disturbance in infantile encephalopathy. Thesis. Dordrecht; Martinus Nijhof 1987
43
Van Wezel-Meijler G, Van der Knaap M S, Sie L TL, Oosting J, van Amerongen A H, Cranendonk A. et al .
Magnetic resonance imaging of the brain in premature infants during the neonatal period. Normal phenomena and reflection of mild ultrasound abnormalities.
Neuropediatrics.
1998;
29
89-96
44 Volpe J J. Hypoxic-ischemic encephalopathy. Volpe JJ Neurology of the Newborn. 3rd ed. Philadelphia; Saunders 1995: 314-369
45
Wood N S, Marlow N, Costeloe K, Gibson A T, Wilkinson A R.
Neurologic and developmental disability after extremely preterm birth.
N Engl J Med.
2000;
343
378-384
Marjo S. van der Knaap
Department of Child Neurology VU University Medical Center
De Boelelaan 1117
1081 HV Amsterdam
The Netherlands
Email: ms.vanderknaap@vumc.nl