ABBREVIATIONS GMIGrey matter injury IVH Intraventricular haemorrhage PVHI Periventricular haemorrhagic venous infarction PVL Periventricular leukomalacia WMI White matter injury AIM The aim of this study was to review the distribution of neuroimaging findings from a contemporary population cohort of individuals with cerebral palsy (CP) and to facilitate standardization of imaging classification. METHOD Publications from 1995 to 2012 reporting imaging findings in population cohortswere selected through a literature search, and review of the titles, abstracts, and content of studies. Relevant data were extracted, including unpublished data from Victoria, Australia. The proportions for each imaging pattern were tabulated, and heterogeneity was assessed for all individuals with CP, and for subgroups based on gestational age, CP subtype, and Gross Motor Function Classification System level.RESULTS Studies from three geographic regions met the inclusion criteria for individuals with CP, and two additional studies reported on specific CP subtypes. Brain abnormalities were observed in 86% of scans, but were observed least often in children with ataxia (24-57%). White matter injury was the most common imaging pattern (19-45%), although the proportions showed high heterogeneity. Additional patterns were grey matter injury (21%), focal vascular insults (10%), malformations (11%), and miscellaneous findings (4-22%).INTERPRETATION This review suggests areas where further dialogue will facilitate progress towards standardization of neuroimaging classification. Standardization will enable future collaborations aimed at exploring the relationships among magnetic resonance imaging patterns, risk factors, and clinical outcomes, and, ultimately, lead to better understanding of causal pathways and opportunities for prevention.Cerebral palsy (CP) is a clinically diagnosed syndrome with multiple aetiological pathways. 1 Adverse events occurring at different developmental stages can result in the same clinical pattern of CP, whereas a similar pathway may produce variable outcomes.2 By providing an in vivo view of brain structure, brain imaging can help to clarify the nature and timing of the insult to the brain.2-5 Early imaging is often performed in children with neonatal complications, to provide an accurate determination of the pathogenic mechanism and to inform decisions about early treatment, prognosis, and ongoing medical management.3 In many children, however, the neonatal period is unremarkable, and motor problems are not appreciated until later in infancy or childhood. At the investigation stage, determination of the nature and timing of the brain abnormality through imaging and clinical history is important for assessment of the recurrence risk, counselling of families, medico-legal purposes, and to limit unnecessary testing. Better categorization of imaging patterns is likely to play a pivotal role in deepening our understanding of the aetiological pathways of CP: a crucial step in the ongoing search for preventative strate...
ABBREVIATIONS GMIGrey RESULTS White matter injury was the most common MRI pattern (45%), followed by grey matter injury (14%), normal imaging (13%), malformations (10%), focal vascular insults (9%), and miscellaneous patterns (7%). Parity, birth gestation, level of neonatal care, Apgar score, and time to established respiration varied between MRI patterns (p<0.01). Nulliparity was most strongly associated with focal vascular insults, whereas multiparity was associated only with malformations. Grey matter injury was not associated with birth in a tertiary unit, but was strongly associated with severe perinatal compromise. The frequency of neonatal seizures and of nursery admissions was lowest among children with malformations.INTERPRETATION As known risk factors for CP are differentially associated with specific MRI patterns, future exploration of causal pathways might be facilitated when performed in pathogenically defined groups.Cerebral palsy (CP) is a disorder of movement and posture that results from a non-progressive disturbance to the developing brain. 1 The condition encompasses a variety of aetiological pathways, pathogenic mechanisms, and clinical manifestations. Magnetic resonance imaging (MRI) provides an in vivo view of brain structure and plays a pivotal role in identification of the most likely pathogenic mechanism. Particular patterns of abnormality on neuroimaging can provide clues as to the nature, timing, and severity of the cerebral injury. Consequently, investigation of potentially preventable antecedent factors is likely to be most informative when performed in subgroups based on neuroimaging patterns. Clinically defined subgroups are less useful for this purpose as different types of adverse event may result in the same clinical pattern of CP and a similar aetiology may produce variable outcomes. 2Three systematic reviews have amalgamated imaging data and determined the proportion of abnormal scans in children with CP; however, few of the included studies used population samples or included all CP subtypes. 2-4More recently, CP registries have adopted comparable classification systems for imaging findings in CP. This has enabled comparison of imaging findings between contemporary population cohorts and has resulted in a small number of papers reporting associations between imaging patterns, birth gestation, and clinical variables. [5][6][7][8] In this study, we aimed to describe the distribution of MRI patterns in a large population-based sample of children with CP and to examine associations between neuroimaging patterns, and antenatal and perinatal factors typically recorded by CP registries. The strength of evidence for causality was also considered, particularly with respect to strength of association, consistency of findings between studies, and biological plausibility. We built on previous work by using a larger, geographically defined cohort, including a range of antenatal and perinatal variables, in addition to birth gestation, and through the use of population comparison data. Our ...
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