title: Development and validation of a semiquantitative brain maturation score on fetal MR images: initial results.
abstract: OBJECTIVE
  To develop a valid, reliable, and simple-to-use semiquantitative visual scale of fetal brain maturation for use in clinical fetal MR imaging assessment and interpretation.
  
  
  METHODS
  This is a retrospective assessment of data from a previous study that was prospective, institutional review board approved, and HIPAA compliant. Forty-eight normal pregnancies with a gestational age (GA) of 25 to 35 weeks were studied. A fetal total maturation score (fTMS) was developed by utilizing six subscores that evaluated cortical sulcation, myelination, and the germinal matrix and provided a single combined numerical value to be evaluated as a marker of brain maturity. The fTMS was correlated with GA and segmented brain volume. A regression model that associated GA based on the visual fTMS scoring was determined. The model was validated with a leave-one-out cross validation procedure.
  
  
  RESULTS
  Mean GA was 29.3 weeks ± 2.9 (standard deviation) (range, 25.2-35.3 weeks) and mean fTMS was 8.6 ± 3.7 (range, 4-16). The intraclass correlation coefficient between the three readers (independent and blinded) was 0.948 (P < .001). The correlations were as follows: GA and brain volume, r = 0.964 (P < .001); fTMS and brain volume, r = 0.970 (P < .001); and GA and fTMS, r = 0.975 (P < .001). A regression model to calculate GA based on fTMS yielded the following equation: calculated GA (weeks) = 22.86 + 0.748 fTMS (P < .001; adjusted R(2) = 0.946). The standard error of the model for calculation of fetal GA from the visual fTMS scale was ± 4.8 days.
  
  
  CONCLUSIONS
  If validated further, the fTMS scale might be used to assess morphologic brain maturity of fetuses between 25 and 35 weeks GA on a single-case basis in a clinical setting.
authors: Department of Radiology, Children's Hospital of Philadelphia, 324 S 34th St, Wood 2115, Philadelphia, PA 19004, USA. vossough@e-mail.chop.edu
authors: Arastoo
authors: A
authors: Vossough
authors: Catherine
authors: C
authors: Limperopoulos
authors: Mary E
authors: ME
authors: Putt
authors: Adre J
authors: AJ
authors: du Plessis
authors: Peter J
authors: PJ
authors: Schwab
authors: Jue
authors: J
authors: Wu
authors: James C
authors: JC
authors: Gee
authors: Daniel J
authors: DJ
authors: Licht
mesh_terms: D001921:Brain / Q000196:embryology*; D001931:Brain Mapping / Q000379:methods*; D016022:Case-Control Studies; D005260:Female; D005865:Gestational Age; D006330:Heart Defects, Congenital; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D011247:Pregnancy; D012044:Regression Analysis; D012189:Retrospective Studies