Detection of Global Brain Injury Using Point-of-Care Neonatal MRI Scanner

Abstract

Background Conventional magnetic resonance imaging (MRI) neuroimaging of infants is complicated by the need to transport infants outside the neonatal intensive care unit (NICU), often to distant areas of the hospital.

Primary Objective The main aim of this study was to evaluate and compare scoring of images from a novel 1T MRI, which enables neuroimaging within the NICU, with those from a conventional MRI.

Secondary Objective The second aim of this study was to document improved expediency, and thereby greater patient safety, as reflected by decreased transport time.

Materials and Methods Thirty premature infants (mean gestational age: 28.8 ± 2.1 weeks) were scanned consecutively on the novel 1T and 1.5T conventional scanners at term-equivalent age. Orthogonal T1- and T2-weighted images were acquired and reviewed. A global brain abnormality score (Kidokoro) was assigned independently to all images by two radiologists. Interrater agreement was evaluated using the kappa statistic and interscanner agreement was evaluated by Bland–Altman analysis. Transport time to and from both scanners was monitored and compared.

Results Weighted kappas were 0.77 (standard error of measurement [SEM] 0.08; confidence interval [CI]: 0.62–0.92) and 0.86 (SEM: 0.07; CI: 0.73–1), for the 1T and 1.5T scanners, respectively, reflecting substantial interrater agreement. Bland–Altman analysis showed excellent agreement between the two scanners.

Transport time was 8 ± 6 minutes for the 1T MRI versus 46 ± 21 minutes for the conventional MRI (p < 0.00001). No adverse events were recorded during transport. Standard transport times will vary from institution to institution.

Conclusion Kidokoro scores are similar when comparing images obtained from a 1T MRI with those of a conventional 1.5T MRI, reflecting comparable image quality. Transport time was significantly decreased using the 1T neonatal MRI.

Keywords

point-of-care MRI - premature infants - brain injury score

Note

The images used in this study were acquired from MRI scans that were funded by Aspect Imaging LTD for another study. The sponsor had no further involvement in the current study. Data collection, analysis and interpretation, writing, and submitting the manuscript for publication were made by the authors. No honorarium, grant, or other forms of payment were given to anyone to produce the manuscript. The travel expenses of Dr. Bin-Nun and Dr. Kasirer, for presenting this study in a conference, were funded by Aspect Imaging. The other authors have no financial relationships relevant to this article to disclose.

^* These authors contributed equally to this work as first authors.

Publication History

Received: 29 November 2021

Accepted: 12 August 2022

Accepted Manuscript online:
17 August 2022

Article published online:
19 January 2023

• References

• 1 Counsell SJ, Rutherford MA, Cowan FM, Edwards AD. Magnetic resonance imaging of preterm brain injury. Arch Dis Child Fetal Neonatal Ed 2003; 88 (04) F269-F274
• 2 Counsell SJ, Tranter SL, Rutherford MA. Magnetic resonance imaging of brain injury in the high-risk term infant. Semin Perinatol 2010; 34 (01) 67-78
• 3 Kwon SH, Vasung L, Ment LR, Huppi PS. The role of neuroimaging in predicting neurodevelopmental outcomes of preterm neonates. Clin Perinatol 2014; 41 (01) 257-283
• 4 Smyser CD, Kidokoro H, Inder TE. Magnetic resonance imaging of the brain at term equivalent age in extremely premature neonates: to scan or not to scan?. J Paediatr Child Health 2012; 48 (09) 794-800
• 5 Plaisier A, Raets MM, van der Starre C. et al. Safety of routine early MRI in preterm infants. Pediatr Radiol 2012; 42 (10) 1205-1211
• 6 Burkitt K, Kang O, Jyoti R, Mohamed AL, Chaudhari T. Comparison of cranial ultrasound and MRI for detecting BRAIN injury in extremely preterm infants and correlation with neurological outcomes at 1 and 3 years. Eur J Pediatr 2019; Jul; 178 (07) 1053-1061
• 7 Inder TE, Wells SJ, Mogridge NB, Spencer C, Volpe JJ. Defining the nature of the cerebral abnormalities in the premature infant: a qualitative magnetic resonance imaging study. J Pediatr 2003; 143 (02) 171-179
• 8 Miller SP, Ferriero DM, Leonard C. et al. Early brain injury in premature newborns detected with magnetic resonance imaging is associated with adverse early neurodevelopmental outcome. J Pediatr 2005; 147 (05) 609-616
• 9 Skiöld B, Vollmer B, Böhm B. et al. Neonatal magnetic resonance imaging and outcome at age 30 months in extremely preterm infants. J Pediatr 2012; 160 (04) 559-566 .e1
• 10 Tich SNT, Anderson PJ, Hunt RW, Lee KJ, Doyle LW, Inder TE. Neurodevelopmental and perinatal correlates of simple brain metrics in very preterm infants. Arch Pediatr Adolesc Med 2011; 165 (03) 216-222
• 11 Kidokoro H, Neil JJ, Inder TE. New MR imaging assessment tool to define brain abnormalities in very preterm infants at term. AJNR Am J Neuroradiol 2013; 34 (11) 2208-2214
• 12 Anderson PJ, Treyvaud K, Neil JJ. 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
• 13 Brouwer MJ, Kersbergen KJ, van Kooij BJM. 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 (05) e0177128
• 14 Omizzolo C, Scratch SE, Stargatt R. et al. Neonatal brain abnormalities and memory and learning outcomes at 7 years in children born very preterm. Memory 2014; 22 (06) 605-615
• 15 Erdei C, El-Dib M. Pediatric Newborn Medicine Clinical Practice Guidelines. Accessed Sep 1, 2022, at: https://www.brighamandwomens.org/assets/BWH/pediatric-newborn-medicine/pdfs/te-mris-for-very-preterm-infants-final.pdf
• 16 Antonov NK, Ruzal-Shapiro CB, Morel KD. et al. Feed and wrap MRI technique in infants. Clin Pediatr (Phila) 2017; 56 (12) 1095-1103
• 17 Paley MN, Hart AR, Lait M, Griffiths PD. An MR-compatible neonatal incubator. Br J Radiol 2012; 85 (1015): 952-958
• 18 Sirin S, Goericke SL, Huening BM. et al. Evaluation of 100 brain examinations using a 3 Tesla MR-compatible incubator-safety, handling, and image quality. Neuroradiology 2013; 55 (10) 1241-1249
• 19 Tkach JA, Merhar SL, Kline-Fath BM, Pratt RG, Loew WM, Daniels BR, Giaquinto RO, Rattan MS, Jones BV, Taylor MD, Tiefermann JM, Tully LM, Murphy EC, Wolf-Severs RN, LaRuffa AA, Dumoulin CL. MRI in the neonatal ICU: initial experience using a small-footprint 1.5-T system. Am J Roentgenol 2014; Jan; 202 (01) W95-W105
• 20 George JM, Fiori S, Fripp J. et al. Validation of an MRI brain injury and growth scoring system in very preterm infants scanned at 29-to 35-week postmenstrual age. AJNR Am J Neuroradiol 2017; 38 (07) 1435-1442