Original article| Volume 44, ISSUE 9, P605-611, October 2022

Verification of the ability of the new MRI classification system to predict neurodevelopmental outcome in very low-birth-weight infants



      Very low-birth-weight infants (VLBWI) are at high risk for adverse neurodevelopmental outcomes. A new, feasible and practical classification system for white matter injury has been reported by Martinez-Biarge et al. Therefore, we investigated the relationship between white matter injury and neurodevelopmental outcomes using this system.

      Materials and methods

      We enrolled a consecutive series of VLBWI birth weights <1500 g between 2012 and 2015. Two radiologists evaluated the brain MRI obtained in the VLBWI at term-equivalent age. MRI findings were classified into six Grades (Grade 0, Ia, Ib, II, III, IV). The frequency of abnormalities in each Grade was examined. The neurodevelopmental outcome of the VLBWI was assessed at two years or older, and we investigated the presence of cerebral palsy (CP) and intellectual disability (ID), and other serious outcomes. We also calculated the simple kappa value before the raters were matched.


      Among 167 VLBWI, 131 met the eligibility criteria. 114 was Grade 0 (87%), 11 was Grade I (8.4%), 3 was Grade II (2.3%), 1 was Grade III (0.8%), and 2 was Grade IV (1.5%). The frequency of any abnormalities of intelligence in Grade 0 was 24%. The frequency of CP in Grade I was 18%. All Grade III and Grade IV cases had mild CP and an ID. The simple kappa value was 0.95.


      The prognostic value of the MRI scoring tool was limited. However, all Grade III and Grade IV cases had mild CP and ID. The results demonstrated an excellent inter-rater correlation.


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        • Platt M.J.
        • Cans C.
        • Johnson A.
        • Surman G.
        • Topp M.
        • Torrioli M.G.
        • et al.
        Trends in cerebral palsy among infants of very low birthweight (<1500 g) or born prematurely (<32 weeks) in 16 European centres: a database study.
        The Lancet. 2007; 369: 43-50
        • Anderson P.
        • Doyle L.W.
        Neurobehavioral outcomes of school-age children born extremely low birth weight or very preterm in the 1990s.
        JAMA. 2003; 289: 3264-3272
        • Volpe J.J.
        • Kinney H.C.
        • Jensen F.E.
        • Rosenberg P.A.
        The developing oligodendrocyte: key cellular target in brain injury in the premature infant.
        Int J Dev Neurosci. 2011; 29: 423-440
        • Woodward L.J.
        • Anderson P.J.
        • Austin N.C.
        • Howard K.
        • Inder T.E.
        Neonatal MRI to predict neurodevelopmental outcomes in preterm infants.
        N Engl J Med. 2006; 355: 685-694
        • Kidokoro H.
        • Neil J.J.
        • Inder T.E.
        New MR imaging assessment tool to define brain abnormalities in very preterm infants at term.
        AJNR Am J Neuroradiol. 2013; 34: 2208-2214
        • Martinez-Biarge M.
        • Groenendaal F.
        • Kersbergen K.J.
        • Benders M.J.N.L.
        • Foti F.
        • Cowan F.M.
        • et al.
        MRI based preterm white matter injury classification: the importance of sequential imaging in determining severity of injury.
        PLoS ONE. 2016; 11: e0156245
        • Martinez-Biarge M.
        • Groenendaal F.
        • Kersbergen K.
        • Benders M.N.L.
        • Foti F.
        • van I.
        • Haastert
        • et al.
        Neurodevelopmental outcomes in preterm infants with white matter injury using a new MRI classification.
        Neonatology. 2019; 116: 227-235
        • Brouwer M.J.
        • Kersbergen K.J.
        • van Kooij B.J.M.
        • Benders M.J.N.L.
        • van Haastert I.C.
        • Koopman-Esseboom C.
        • et al.
        Preterm brain injury on term-equivalent age MRI in relation to perinatal factors and neurodevelopmental outcome at two years.
        PLoS ONE. 2017; 12: e0177128
        • Nanba Y.
        • Matsui K.
        • Aida N.
        • Sato Y.
        • Toyoshima K.
        • Kawataki M.
        • et al.
        Magnetic resonance imaging regional T1 abnormalities at term accurately predict motor outcome in preterm infants.
        Pediatrics. 2007; 120: e10-e19
        • Anderson P.J.
        • Treyvaud K.
        • Neil J.J.
        • Cheong J.L.Y.
        • Hunt R.W.
        • Thompson D.K.
        • et al.
        Associations of newborn brain magnetic resonance imaging with long-term neurodevelopmental impairments in very preterm children.
        J Pediatr. 2017; 187 (58–65 e1)
        • Hintz S.R.
        • O’Shea M.
        Neuroimaging and neurodevelopmental outcomes in preterm infants.
        Semin Perinatol. 2008; 32: 11-19
        • Woodward L.J.
        • Clark C.A.C.
        • Bora S.
        • Inder T.E.
        • Baud O.
        Neonatal white matter abnormalities an important predictor of neurocognitive outcome for very preterm children.
        PLoS ONE. 2012; 7: e51879
        • Brown N.C.
        • Inder T.E.
        • Bear M.J.
        • Hunt R.W.
        • Anderson P.J.
        • Doyle L.W.
        Neurobehavior at term and white and gray matter abnormalities in very preterm infants.
        J Pediatr. 2009; 155 (32-8, 8.e1)