title: Optimization of MRI-based scoring scales of brain injury severity in children with unilateral cerebral palsy.
abstract: BACKGROUND
  Several scoring systems for measuring brain injury severity have been developed to standardize the classification of MRI results, which allows for the prediction of functional outcomes to help plan effective interventions for children with cerebral palsy.
  
  
  OBJECTIVE
  The aim of this study is to use statistical techniques to optimize the clinical utility of a recently proposed template-based scoring method by weighting individual anatomical scores of injury, while maintaining its simplicity by retaining only a subset of scored anatomical regions.
  
  
  METHODS
  Seventy-six children with unilateral cerebral palsy were evaluated in terms of upper limb motor function using the Assisting Hand Assessment measure and injuries visible on MRI using a semiquantitative approach. This cohort included 52 children with periventricular white matter injury and 24 with cortical and deep gray matter injuries. A subset of the template-derived cerebral regions was selected using a data-driven region selection algorithm. Linear regression was performed using this subset, with interaction effects excluded.
  
  
  RESULTS
  Linear regression improved multiple correlations between MRI-based and Assisting Hand Assessment scores for both periventricular white matter (R squared increased to 0.45 from 0, P < 0.0001) and cortical and deep gray matter (0.84 from 0.44, P < 0.0001) cohorts. In both cohorts, the data-driven approach retained fewer than 8 of the 40 template-derived anatomical regions.
  
  
  CONCLUSIONS
  The equal or better prediction of the clinically meaningful Assisting Hand Assessment measure using fewer anatomical regions highlights the potential of these developments to enable enhanced quantification of injury and prediction of patient motor outcome, while maintaining the clinical expediency of the scoring approach.
authors.affiliation: CSIRO Digital Productivity and Services Flagship, The Australian e-Health Research Centre, Royal Brisbane and Women's Hospital, Level 5, UQ Health Sciences Building, Herston, QLD, 4029, Australia. alexpagnozzi1@gmail.com.|School of Medicine, The University of Queensland, St. Lucia, Brisbane, Australia. alexpagnozzi1@gmail.com.
authors.forename: Alex M
authors.identifier: http://orcid.org/0000-0001-7931-1204
authors.initials: AM
authors.lastname: Pagnozzi
authors.affiliation: Stella Maris Scientific Institute, Pisa, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Fiori
authors.affiliation: Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia.
authors.forename: Roslyn N
authors.initials: RN
authors.lastname: Boyd
authors.affiliation: Stella Maris Scientific Institute, Pisa, Italy.|Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Guzzetta
authors.affiliation: CSIRO Digital Productivity and Services Flagship, The Australian e-Health Research Centre, Royal Brisbane and Women's Hospital, Level 5, UQ Health Sciences Building, Herston, QLD, 4029, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Doecke
authors.affiliation: Centre for Medical Diagnostic Technologies in Queensland, The University of Queensland, St. Lucia, Brisbane, Australia.
authors.forename: Yaniv
authors.initials: Y
authors.lastname: Gal
authors.affiliation: CSIRO Digital Productivity and Services Flagship, The Australian e-Health Research Centre, Royal Brisbane and Women's Hospital, Level 5, UQ Health Sciences Building, Herston, QLD, 4029, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Rose
authors.affiliation: CSIRO Digital Productivity and Services Flagship, The Australian e-Health Research Centre, Royal Brisbane and Women's Hospital, Level 5, UQ Health Sciences Building, Herston, QLD, 4029, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Dowson
mesh_terms: D000293:Adolescent; D000465:Algorithms; D001921:Brain / Q000473:pathology*; D001930:Brain Injuries / Q000209:etiology / Q000473:pathology*; D002547:Cerebral Palsy / Q000150:complications / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015599:Trauma Severity Indices
keywords: Assisting Hand Assessment; Brain injury; Cerebral palsy; Child; Magnetic resonance imaging; Structural assessment