MRI-based radiologic scoring system for extent of brain injury in children with hemiplegia

BACKGROUND AND PURPOSE: 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.

MATERIALS AND 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- (p = 0.909, P < .001) and intrarater (p = 0.926, P =<.001) reliability was demonstrated. Radiologic score correlated significantly with manual ability classification systems (p = 0.708, P < .001), and with motor assessments (assisting hand assessment [p = <0.753, P < .001]; Jebsen Taylor test of hand function [p = 0. 766, P < .001]; children's hand experience questionnaire [p=<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.