MRI-based radiologic scoring system for extent of brain injury in children with hemiplegia.
OBJECTIVE
Brain MR imaging is recommended in children with cerebral palsy. Descriptions of MR imaging findings lack uniformity, due to the absence of a validated quantitative approach. We developed a quantitative scoring method for brain injury based on anatomic MR imaging and examined the reliability and validity in correlation to motor function in children with hemiplegia.


METHODS
Twenty-seven children with hemiplegia underwent MR imaging (T1, T2-weighted sequences, DTI) and motor assessment (Manual Ability Classification System, Gross Motor Functional Classification System, Assisting Hand Assessment, Jebsen Taylor Test of Hand Function, and Children's Hand Experience Questionnaire). A scoring system devised in our center was applied to all scans. Radiologic score covered 4 domains: number of affected lobes, volume and type of white matter injury, extent of gray matter damage, and major white matter tract injury. Inter- and intrarater reliability was evaluated and the relationship between radiologic score and motor assessments determined.


RESULTS
Mean total radiologic score was 11.3 ± 4.5 (range 4-18). Good inter- (ρ = 0.909, P < .001) and intrarater (ρ = 0.926, P = < .001) reliability was demonstrated. Radiologic score correlated significantly with manual ability classification systems (ρ = 0.708, P < .001), and with motor assessments (assisting hand assessment [ρ = -0.753, P < .001]; Jebsen Taylor test of hand function [ρ = 0. 766, P < .001]; children's hand experience questionnaire [ρ = -0. 716, P < .001]), as well as with DTI parameters.


CONCLUSIONS
We present a novel MR imaging-based scoring system that demonstrated high inter- and intrarater reliability and significant associations with manual ability classification systems and motor evaluations. This score provides a standardized radiologic assessment of brain injury extent in hemiplegic patients with predominantly unilateral injury, allowing comparison between groups, and providing an additional tool for counseling families.
From the Pediatric Radiology Unit (S.I.S.) shellyshiran@gmail.com.
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Shiran
Functional Brain Center, The Wohl Institute for Advanced Imaging (M.W., V.M., D.B.B.), Tel Aviv Sourasky Medical Center, Tel Aviv, Israel Department of Psychology (M.W.), Gonda Multidisciplinary Brain Research Centre, Bar Ilan University, Ramat Gan, Israel.
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Weinstein
Department of Radiology (C.S.-C.).
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Sirota-Cohen
Functional Brain Center, The Wohl Institute for Advanced Imaging (M.W., V.M., D.B.B.), Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
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Myers
Functional Brain Center, The Wohl Institute for Advanced Imaging (M.W., V.M., D.B.B.), Tel Aviv Sourasky Medical Center, Tel Aviv, Israel Sackler Faculty of Medicine (D.B.B., A.F.-V.), Tel Aviv University, Tel Aviv, Israel Sagol School of Neuroscience (D.B.B.), Tel Aviv University, Tel Aviv, Israel.
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Ben Bashat
Sackler Faculty of Medicine (D.B.B., A.F.-V.), Tel Aviv University, Tel Aviv, Israel Department of Child Neurology (A.F.-V., M.S.), Dana-Dwek Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
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Fattal-Valevski
Center for Rehabilitation (D.G.), Oxford Brookes University, Oxford, UK.
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Green
Department of Child Neurology (A.F.-V., M.S.), Dana-Dwek Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel Pediatric Neurology and Child Development Service-Meuhedet North (M.S.), Haifa, Israel.
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Schertz
D000293:Adolescent; D001930:Brain Injuries / Q000145:classification* / Q000175:diagnosis*; D002648:Child; D005260:Female; D006429:Hemiplegia / Q000145:classification* / Q000175:diagnosis*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009460:Neurologic Examination