PREDICTION OF NEUROMOTOR OUTCOME IN PERINATAL ASPHYXIA - EVALUATION OF MR SCORING SYSTEMS

PURPOSE: We developed a scoring system for the assessment of perinatal asphyxia as depicted on MR images. METHODS: Four scoring systems were derived to evaluate MR images obtained in asphyxiated neonates: the b asal ganglia (BG) score, the watershed (W) score, the combined basal g anglia/watershed (BG/W) score, and the sum of the BG and W scores, the summation (S) score, In addition, three MR sequences, T1-weighted, fi rst-echo T2-weighted, and second-echo T2-weighted, were assessed for e ach patient for each scoring system, Neuromotor examinations were perf ormed at ages 3 and 12 months, and cognitive development was tested at age 12 months, Statistical analysis was then performed to test the re lationship between the MR scores and the outcome scores. RESULTS: The BG/W score, obtained with the first-echo T2-weighted sequence, was the most useful overall score for predicting neuromotor outcome at 3 and 12 months and cognitive outcome at 12 months, T1-weighted and first-ec ho T2-weighted sequences showed a stronger association with outcome in patients imaged during the first postnatal week whereas second-echo T 2-weighted sequences showed a stronger association with outcome in pat ients imaged during the second postnatal week. CONCLUSION: It appears that, with the use of the BG/W score, MR imaging discriminates accurat ely between patients with good and poor neuromotor and cognitive outco me at 3 and 12 months, In terms of our scoring systems, the first-echo T2-weighted sequence appears to discriminate best between patients wi th good and poor 3- and 12-month outcomes, Proper use of the imaging s equences and scoring systems described in this article can increase th e knowledge base upon which treatment decisions are made in asphyxiate d neonates.