Characterization of Clinical Magnetic Resonance Imaging Findings in Moderate-Late Preterm Infants Diagnosed With Cerebral Palsy: A Single-Center Retrospective Study

Background

Cerebral palsy (CP) is the most common movement disorder in childhood and is associated with both brain injury and prematurity. Approximately 10% of patients have a normal brain magnetic resonance imaging (MRI), and current practices suggest genetic testing may be indicated for those patients. However, given that prematurity itself is a risk factor for CP, which MRI patterns are present in premature infants and whether MRI patterns are associated with genetic causes in this population are unclear. While white matter injury is the dominant underlying cause of CP in premature infants, moderate prematurity between 32 and 34 weeks’ gestational age represents a transitional period to a more diverse set of CP-causing brain injuries.

Methods

A single-center retrospective case review of a 65 CP patient cohort was performed. Patients were identified as moderate-late preterm infants based on gestational age in the EMR, and those who had MRI reports available in the medical record, was analyzed. Five subcategories of MRI findings were defined as follows: 1) normal, 2) nonspecific, unlikely causal, 3) nonspecific, likely causal, 4) acquired pathology, and 5) congenital/structural. Comorbidities, disease burden, and genetic testing were compared across the imaging subcategories with no notable differences identified.

Results

Initial review indicated that 95% of patients fall into an abnormal MRI category. Genetic testing was sent on 34% of patients in the cohort and a diagnosis was identified in 13% of all patients, but no statistical differences in genetic testing were noted across MRI groups. Respiratory status, feeding status, rates of epilepsy, verbal status, ambulatory status, and intellectual disability were not statistically different between MRI categories.

Conclusions

In this single-center cohort of moderate-late preterm infants with CP, abnormal MRI findings were identified frequently. However, for this cohort, abnormal imaging findings were not correlated with either disease burden or genetic testing utilization.