Supplementary Material for: Early Conventional MRI for Prediction of Neurodevelopmental Impairment in Extremely-Low-Birth-Weight Infants

<b><i>Background:</i></b> Extremely-low-birth-weight (ELBW; ≤1,000 g) infants are at high risk for neurodevelopmental impairments. Conventional brain MRI at term-equivalent age is increasingly used for prediction of outcomes. However, optimal prediction models remain to be determined, especially for cognitive outcomes. <b><i>Objective:</i></b> The aim was to evaluate the accuracy of a data-driven MRI scoring system to predict neurodevelopmental impairments. <b><i>Methods:</i></b> 122 ELBW infants had a brain MRI performed at term-equivalent age. Conventional MRI findings were scored with a standardized algorithm and tested using a multivariable regression model to predict neurodevelopmental impairment, defined as one or more of the following at 18-24 months' corrected age: cerebral palsy, bilateral blindness, bilateral deafness requiring amplification, and/or cognitive/language delay. Results were compared with a commonly cited scoring system. <b><i>Results:</i></b> In multivariable analyses, only moderate-to-severe gyral maturational delay was a significant predictor of overall neurodevelopmental impairment (OR: 12.6, 95% CI: 2.6, 62.0; p &lt; 0.001). Moderate-to-severe gyral maturational delay also predicted cognitive delay, cognitive delay/death, and neurodevelopmental impairment/death. Diffuse cystic abnormality was a significant predictor of cerebral palsy (OR: 33.6, 95% CI: 4.9, 229.7; p &lt; 0.001). These predictors exhibited high specificity (range: 94-99%) but low sensitivity (30-67%) for the above outcomes. White or gray matter scores, determined using a commonly cited scoring system, did not show significant association with neurodevelopmental impairment. <b><i>Conclusions:</i></b> In our cohort, conventional MRI at term-equivalent age exhibited high specificity in predicting neurodevelopmental outcomes. However, sensitivity was suboptimal, suggesting additional clinical factors and biomarkers are needed to enable accurate prognostication.

**背景：** 超低出生体重儿（Extremely-low-birth-weight, ELBW；出生体重≤1000g）发生神经发育障碍的风险极高。足月等效年龄时的常规颅脑磁共振成像（Magnetic Resonance Imaging, MRI）正越来越多地被用于预后预测，但目前仍未确立最优的预测模型，针对认知结局的预测模型尤为如此。
**研究目的：** 旨在评估一种数据驱动的MRI评分系统预测神经发育障碍的准确性。
**研究方法：** 本研究纳入122例ELBW患儿，均于足月等效年龄行颅脑MRI检查。采用标准化算法对常规MRI影像表现进行评分，并通过多变量回归模型预测神经发育障碍；神经发育障碍定义为校正胎龄18~24月龄时存在以下任意一项或多项：脑性瘫痪、双侧失明、需辅助装置的双侧耳聋，以及/或认知/语言发育迟缓。研究将上述结果与一项广为引用的评分系统进行对比。
**研究结果：** 多变量分析显示，仅中至重度脑回成熟延迟是整体神经发育障碍的显著预测因素（比值比（Odds Ratio, OR）=12.6，95%置信区间（Confidence Interval, CI）：2.6~62.0；P<0.001）。中至重度脑回成熟延迟同样可预测认知发育迟缓、认知发育迟缓/死亡，以及神经发育障碍/死亡。弥漫性囊性异常是脑性瘫痪的显著预测因素（OR=33.6，95%CI：4.9~229.7；P<0.001）。上述预测因素针对上述结局的特异性较高（94%~99%），但敏感性较低（30%~67%）。采用广为引用的评分系统得出的白质或灰质评分，与神经发育障碍无显著关联。
**研究结论：** 在本研究队列中，足月等效年龄时的常规颅脑MRI在预测神经发育结局方面具有较高的特异性，但敏感性欠佳，这提示需结合额外的临床因素与生物标志物，方能实现精准的预后评估。