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Comment & Response
February 2018

Are Structural Magnetic Resonance Imaging and General Movements Assessment Sufficient for Early, Accurate Diagnosis of Cerebral Palsy?

Author Affiliations
  • 1Perinatal Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
  • 2Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
JAMA Pediatr. 2018;172(2):198-199. doi:10.1001/jamapediatrics.2017.4812

To the Editor A systematic review and clinical practice guideline on early, accurate diagnosis and early intervention in cerebral palsy (CP), as undertaken by Novak et al,1 is a timely addition to the literature. However, it is unclear why the authors restricted their search criteria to only systematic reviews/meta-analyses and CPGs. By doing so, they overlooked several relevant, well-conducted prognostic studies.25 Unfortunately, this casts significant doubt on their recommendation to combine structural brain magnetic resonance imaging (MRI) with general movements assessment (GMA) for accurate diagnosis of CP before age 5 months. They report MRI to possess a sensitivity of 86% to 89%. However, these data were derived from a clinical practice guideline that examined cross-sectional MRI studies (reference 27 in the Novak et al article),1 which are unable to determine prognostic test properties, and from a systematic review that found only 1 eligible cohort study of 61 preterm infants (reference 21 in the Novak et al article).1 They excluded the largest MRI study in preterm infants (N = 445),2 which yielded a sensitivity of 48% and likelihood ratio for a positive test result (LR+) of 2.8 for CP prediction. A 2015 meta-analysis,3 also excluded, reported a similarly low LR+ of 3.7 for MRI. When applied to a very preterm infant (assuming 10% CP prevalence) with an abnormal MRI, a LR+ of 3.7 only increases this infant’s probability of developing CP to 29%.

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