MRIclassification system (MRICS) for children with cerebral palsy: development, reliability, and recommendations

Abstract

AIM To develop and evaluate a classification system for magnetic resonance imaging (MRI) findings of children with cerebral palsy (CP) that can be used in CP registers.METHOD The classification system was based on pathogenic patterns occurring in different periods of brain development. The MRI classification system (MRICS) consists of five main groups: maldevelopments, predominant white matter injury, predominant grey matter injury, miscellaneous, and normal findings. A detailed manual for the descriptions of these patterns was developed, including test cases (www.scpenetwork.eu/en/my-scpe/rtm/neuroimaging/ cp-neuroimaging/). A literature review was performed and MRICS was compared with other classification systems. An exercise was carried out to check applicability and interrater reliability. Professionals working with children with CP or in CP registers were invited to participate in the exercise and chose to classify either 18 MRIs or MRI reports of children with CP.RESULTS Classification systems in the literature were compatible with MRICS and harmonization possible. Interrater reliability was found to be good overall (k=0.69; 0.54-0.82) among the 41 participants and very good (k=0.81; 0.74-0.92) using the classification based on imaging reports.INTERPRETATION Surveillance of Cerebral Palsy in Europe (SCPE) proposes the MRICS as a reliable tool. Together with its manual it is simple to apply for CP registers.Surveillance of Cerebral Palsy in Europe (SCPE) has, through agreement in definitions and classifications of cerebral palsy (CP), developed a common language in the domain of CP.1,2 This has been a prerequisite for comparative studies, 3,4 and for studies which necessitate a large population basis. 4,5 This common language has generated a lot of interest even beyond Europe: the definitions and classifications are widely used, and SCPE papers extensively cited.CP is a clinical diagnosis, based upon neurological symptoms and a motor disorder causing an activity limitation.6 SCPE does not consider neuroimaging a prerequisite for the diagnosis of CP.2 Up to now, normal magnetic resonance imaging (MRI) does not exclude the diagnosis of CP. Moreover, neuroimaging, especially MRI, is not available nor used in all countries to the same extent. In addition, the use of MRI, as well as knowledge of its role in the understanding of CP pathogenesis, has dramatically increased during the last 15 years, which would make comparison between countries and time periods difficult. Most importantly, there is no commonly agreed neuroimaging classification for CP at this time.Although neuroimaging is not part of the CP definition, neuroimaging findings are abnormal in more than 80% of children with CP, 7-9 disclosing the pathogenic pattern responsible for the CP. Neuroimaging may also help to understand the structure-function relationship. 10,11 National guidelines recommend MRI as the first diagnostic step after history taking, neurological examination, and examination of additional impairments.12 Therefore, a need was exp...

A common data language for clinical research studies: the National Institute of Neurological Disorders and Stroke and American Academy for Cerebral Palsy and Developmental Medicine Cerebral Palsy Common Data Elements Version 1.0 recommendations

“…Moreover, the Surveillance of Cerebral Palsy in Europe group published a classification system for standardizing the abnormal findings of brain MRI in children with CP. 71 Their approach was different from the NINDS CDE project in that they tried to define categories of patterns of involvement for research studies. The NINDS CDE for CP approach was to promote coding and documentation of all abnormal findings in a consistent manner but with less focus on interpretation and categorizing patterns of involvement.…”

Intellectual disability in cerebral palsy: a population‐based retrospective study

“…We know of only one previous publication relating the prevalence of intellectual disability to cerebral pathology. On the basis of classification of patterns of injury on brain magnetic resonance imaging (MRI), the highest rate of intellectual disability was seen in individuals with cerebral malformations (>70%) and the lowest in those with a predominantly white matter injury pattern (<30%) …”

“…12 We know of only one previous publication relating the prevalence of intellectual disability to cerebral pathology. On the basis of classification of patterns of injury on brain magnetic resonance imaging (MRI), 13 the highest rate of intellectual disability was seen in individuals with cerebral malformations (>70%) and the lowest in those with a predominantly white matter injury pattern (<30%). 8 The objectives of this study were to describe the epidemiology of intellectual disability in CP in terms of clinical and neuroimaging associations, and to report the impact of intellectual disability on utilization of health services and longevity.…”

Brain Lesions in Children with Unilateral Spastic Cerebral Palsy

“…It is the second most common CP subtype, that is reported in around 25% of children with CP (4). Neuroimaging, especially magnetic resonance imaging (MRI) is very useful diagnostic procedure that is commonly used in clinical evaluation of children with CP (5,6). The brain MRI may help to identify the type and timing of lesions that cause CP and may help to provide early prognosis of motor outcome, but also occurrence and severity of associated disabilities.…”