Background

Magnetic resonance imaging (MRI) scores have been well validated in moderate/severe hypoxic-ischemic encephalopathy (HIE). Infants with mild HIE can have different patterns of injury, yet different scores have not been compared in this group of infants. Our objective was to compare the ability of three = MRI scores to detect abnormalities in infants with mild HIE, and infants with moderate/severe HIE were included for comparison.

Methods

This is a single-center prospective cohort study of infants ≥36 weeks’ gestation with HIE born at a level III neonatal intensive care unit from 2017 to 2019. All infants with HIE underwent an MRI, but only infants with moderate/severe HIE underwent therapeutic hypothermia. At least two experienced MRI readers who were unaware of all clinical variables independently assigned three scores (Barkovich, NICHD NRN, and Weeke).

Results

A total of 42 newborns with varying HIE severity underwent MRI on day five of life. In the overall cohort, abnormalities were reported in three (7%) infants using the Barkovich, in 10 (24%) using the NICHD NRN, and in 24 (57%) using the Weeke score. Agreement was excellent for each score: Barkovich score (k = 1.0), NICHD NRN (k = 0.92), and Weeke score (k = 0.9).

Conclusions

Subtle injury due to mild HIE was detected with the highest frequency using the Weeke score, while inter-rater reliability was excellent for all three scores. These findings suggest that infants with mild HIE and subtle MRI abnormalities may benefit from detailed scoring systems, which is important for studies investigating the benefit of hypothermia in mild HIE.

中文翻译：

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MRI 评分检测轻度缺氧缺血性脑病异常的能力

背景

磁共振成像 (MRI) 评分已在中度/重度缺氧缺血性脑病 (HIE) 中得到很好的验证。患有轻度 HIE 的婴儿可能有不同的损伤模式，但尚未在这组婴儿中比较不同的分数。我们的目标是比较三 = MRI 评分检测轻度 HIE 婴儿异常的能力，并纳入中度/重度 HIE 婴儿进行比较。

方法

这是一项单中心前瞻性队列研究，对 2017 年至 2019 年在 III 级新生儿重症监护病房出生的 HIE ≥36 周的婴儿进行了研究。所有 HIE 婴儿都接受了 MRI 检查，但只有中度/重度 HIE 婴儿接受了治疗低温。至少两名不了解所有临床变量的有经验的 MRI 读者独立分配了三个分数（Barkovich、NICHD NRN 和 Weeke）。

结果

共有 42 名 HIE 严重程度不同的新生儿在出生后的第 5 天接受了 MRI 检查。在整个队列中，使用 Barkovich 评分的 3 名 (7%) 婴儿、使用 NICHD NRN 的 10 名 (24%) 婴儿和使用 Weeke 评分的 24 名 (57%) 婴儿报告了异常。每个分数的一致性都很好：Barkovich 分数 (k = 1.0)、NICHD NRN (k = 0.92) 和 Weeke 分数 (k = 0.9)。

结论

使用 Weeke 评分以最高频率检测到由轻度 HIE 引起的轻微损伤，而所有三个评分的评分者间可靠性都非常好。这些发现表明，患有轻度 HIE 和轻微 MRI 异常的婴儿可能会受益于详细的评分系统，这对于调查低温对轻度 HIE 的益处的研究很重要。