Supplementary Material for: Outcome Prediction and Inter-Rater Comparison of Four Brain Magnetic Resonance Imaging Scoring Systems of Infants with Perinatal Asphyxia and Therapeutic Hypothermia

Introduction: The brain magnetic resonance imaging (MRI) result is a major predictor for the outcome of term infants with perinatal asphyxia who underwent therapeutic hypothermia. In daily practice, no uniform method is used to assess these images. Purpose: The aim of this study was to determine which MRI-score best predicts adverse outcome at 24 months of age and has the highest inter-rater reliability. Methods: Four MRI scoring systems for term infants with perinatal asphyxia were selected: Rutherford score, Trivedi score, Weeke score, and NICHD NRN score. Experienced blinded raters retrospectively evaluated the brain MR Images of 161 infants using all four scoring systems. Long-term outcome (the composite outcome death or adverse outcome, and its separate components) were routinely assessed by standardized testing at the age of 24 months. The predictive accuracy was assessed by logistic regression analyses and expressed as area under the ROC curve (AUC). The inter-rater reliability of the scores was calculated by the weighted Kappa or intraclass correlation. A sensitivity analysis using only high-quality MRI scans was performed. Results: All four MRI scoring systems demonstrated an AUC of >0.66 for the prediction of adverse outcome and ≥0.80 for the prediction of death. The inter-rater reliability analyses demonstrated the highest reliability for the Weeke and Trivedi scores. When only assessing the high-quality scans, the AUC increased further. Conclusion: All four MRI brain scores proved reliable predictors for an adverse outcome at 24 months of age. The Weeke and Trivedi score demonstrated the highest inter-rater reliability. The use of high-quality MRI further improved prediction.

引言：胎儿期窒息合并治疗性低温的足月新生儿脑磁共振成像（MRI）结果，是预测此类新生儿预后的一大关键指标。在日常临床实践中，评估此类影像并无统一的方法。研究目的：本研究的目的是确定哪种MRI评分系统最能预测24个月大时的不良预后，并具备最高的评分者间一致性。研究方法：选取了四种针对胎儿期窒息足月新生儿的MRI评分系统：Rutherford评分、Trivedi评分、Weeke评分和NICHD NRN评分。经验丰富的盲法评分者在回顾性评估161名婴儿的脑MRI图像时，使用了所有四种评分系统。长期预后（包括死亡或不良预后的复合结局及其单独的组成部分）通过标准化测试在24个月大时进行常规评估。通过逻辑回归分析评估预测准确性，并以ROC曲线下面积（AUC）表示。评分者间一致性通过加权Kappa系数或类内相关系数计算。对仅使用高质量MRI扫描进行了敏感性分析。结果：所有四种MRI评分系统在预测不良预后方面均显示出AUC大于0.66，在预测死亡方面AUC达到或超过0.80。评分者间一致性分析显示，Weeke和Trivedi评分具有最高的可靠性。仅评估高质量扫描时，AUC值进一步增加。结论：所有四种MRI脑评分均被证明是24个月大时不良预后的可靠预测指标。Weeke和Trivedi评分显示了最高的评分者间一致性。高质量MRI的使用进一步提升了预测准确性。