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Sensorimotor tract biomarkers, brain injury predict cerebral palsy in preemies

11 Sep 2019

Early brain injury and at least one sensorimotor immaturity precede cerebral palsy (CP) in very preterm infants and may be considered as reliable predictors, a recent study has found.

Researchers enrolled a prospective pilot cohort of 41 preterm infants of extremely low birthweight (1,000 g). Structural and diffusion magnetic resonance imaging (MRI) at term-corrected age was performed to evaluate the brain’s sensorimotor network microstructure. The presence of cerebral palsy was assessed at 18–22 months of age.

Of the participants, only five developed CP (median gestational age, 25.4 weeks; 80.0 percent male); the remaining 36 did not (median gestational age, 25.5 weeks; 61.1 percent male). Two of the CP patients did not show any severe abnormalities upon structural MRI, and were considered as false negative cases, while one with severe abnormalities was not ultimately diagnosed with CP.

Overall, severe abnormalities shown on structural MRI had a sensitivity and specificity of 60.0 percent and 97.1 percent, respectively, for predicting CP development.

Moreover, researchers also found significant between-group differences in all the different microstructural parameters across six segmented sensorimotor tracts analysed: posterior midbody, isthmus, superior thalamic radiations (STR)-sensory, STR-motor and corticospinal tract (CST).

The right fractional anisotropy (p=0.019) and right radial diffusivity (p=0.028) of the CST, for example, were significantly different between CP and non-CP patients.

Different combinations of these sensorimotor tract biomarkers achieved different levels of predictive power. For instance, the combination of STR fractional anisotropy, CST radial diffusivity and STR-motor axial diffusivity had low sensitivity (40–60 percent) but high specificity (97–100 percent). The first two parameters, together, could correctly classify 95 percent of the infants.

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