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Diffuse excessive high signal intensity on term equivalent MRI does not predict disability: a systematic review and meta-analysis
  1. Chandra Prakash Rath1,2,
  2. Saumil Desai1,2,
  3. Shripada C Rao1,2,3,
  4. Sanjay Patole2,3
  1. 1Neonatal Intensive Care Unit, Perth Children's Hospital, Nedlands, Western Australia, Australia
  2. 2Neonatal Intensive Care Unit, King Edward Memorial Hospital for Women Perth, Subiaco, Western Australia, Australia
  3. 3School of Medicine, University of Western Australia, Perth, Western Australia, Australia
  1. Correspondence to Dr Shripada C Rao, Neonatal Intensive Care Unit, Perth Children's Hospital, Nedlands, WA 6009, Australia; shripada.rao{at}health.wa.gov.au

Abstract

Objective To evaluate whether diffuse excessive high signal intensity (DEHSI) on term equivalent age MRI (TEA-MRI) predicts disability in preterm infants.

Design This is a systematic review and meta-analysis. Medline, EMBASE, Cochrane Library, EMCARE, Google Scholar and MedNar databases were searched in July 2019. Studies comparing developmental outcomes of isolated DEHSI on TEA-MRI versus normal TEA-MRI were included. Two reviewers independently extracted data and assessed the risk of bias. Meta-analysis was undertaken where data were available in a format suitable for pooling.

Main outcome measures Neurodevelopmental outcomes ≥1 year of corrected age based on validated tools.

Results A total of 15 studies (n=1832) were included, of which data from 9 studies were available for meta-analysis. The pooled estimate (n=7) for sensitivity of DEHSI in predicting cognitive/mental disability was 0.58 (95% CI 0.34 to 0.79) and for specificity was 0.46 (95% CI 0.20 to 0.74). The summary area under the receiver operating characteristics (ROC) curve was low at 0.54 (CI 0.50 to 0.58). A pooled diagnostic OR (DOR) of 1 indicated that DEHSI does not discriminate preterm infants with and without mental disability. The pooled estimate (n=8) for sensitivity of DEHSI in predicting cerebral palsy (CP) was 0.57 (95% CI 0.37 to 0.75) and for specificity was 0.41 (95% CI 0.24 to 0.62). The summary area under the ROC curve was low at 0.51 (CI 0.46 to 0.55). A pooled DOR of 1 indicated that DEHSI does not discriminate between preterm infants with and without CP.

Conclusions DEHSI on TEA-MRI did not predict future development of cognitive/mental disabilities or CP.

PROSPERO registration number CRD42019130576.

  • diffuse excessive high signal intensity
  • cerebral palsy
  • developmental outcomes
  • magnetic resonance imaging
  • DEHSI
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Footnotes

  • Contributors CPR conceptualised and designed the study and data collection instruments, searched the literature, collected the data, contacted the authors, drafted the initial manuscript, and reviewed the manuscript. SCR conceptualised and designed the study and data collection instruments, searched the literature, collected the data, conducted the statistical analysis, drafted the initial manuscript, and reviewed and revised the manuscript. SD searched the literature, collected the data, contacted the authors, drafted the initial manuscript, and reviewed and revised the manuscript. SP coordinated and supervised the data collection, interpreted the results and critically reviewed the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. The data used in this systematic review and meta-analysis were garnered from the published manuscripts and through communication with the authors of the included studies. Data are available from the corresponding author.

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