Diagnostic accuracy of early neonatal MRI in predicting adverse motor outcomes in children born preterm: Systematic review and meta-analysis.

Aim: To examine the diagnostic accuracy of Early structural and diffusion-weighted magnetic resonance imaging (MRI) (acquired at < 36 weeks postmenstrual age) to detect cerebral palsy (CP) or other adverse motor outcomes at or beyond 3 years corrected age in infants born preterm.

Method: In this systematic review and meta-analysis, we searched the CINAHL, Embase, PubMed, and Web of Science databases for studies without language restrictions and a prospectively registered protocol up to October 2023. We extracted the study details, associations presented, and meta-analyses conducted with pooled sensitivity and specificity.

Results: Twenty-seven articles met the overall inclusion criteria. White matter injury, cerebellar haemorrhage, intraventricular haemorrhage, and lower thalamic volume were associated with poorer motor outcomes. Abnormal Early structural MRI detected infants with a later diagnosis of CP (n = 448, eight studies) with a pooled sensitivity of 98% (95% confidence interval [CI] = 86-100), specificity of 75% (95% CI = 51-93), and adverse motor outcomes (n = 215, four studies), with a pooled sensitivity of 39% (95% CI = 20-59) and a specificity of 90% (95% CI = 88-94).

Interpretation: Early abnormal structural MRI predicted later CP with high sensitivity and specificity, while specificity was higher than sensitivity in predicting adverse motor outcomes using the Movement Assessment Battery for Children, Second Edition. Further research into diagnostic accuracy and association between Early MRI and long-term motor outcomes is warranted.