Normal Imaging in Patients with Cerebral Palsy: What Does It Tell Us?

Objective To identify distinctive clinical features characterizing children with cerebral palsy (CP) and normal-appearing magnetic resonance imaging (MRI) findings. Study design Using a population-based CP registry, the Registre de la Paralysie Cérébrale au Québec (Quebec Cerebral Palsy Registry), v...

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Published in:The Journal of pediatrics 2013-02, Vol.162 (2), p.369-374.e1
Main Authors: Benini, Ruba, MD, PhD, Dagenais, Lynn, BSc, Shevell, Michael I., MD, CM, FRCP
Format: Article
Language:English
Subjects:
cerebral palsy
Cerebral Palsy - diagnosis
Child, Preschool
children
False Negative Reactions
Female
females
Humans
image analysis
Infant
Magnetic Resonance Imaging
Male
males
pathophysiology
patients
Pediatrics
phenotype
Reference Values
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Summary:Objective To identify distinctive clinical features characterizing children with cerebral palsy (CP) and normal-appearing magnetic resonance imaging (MRI) findings. Study design Using a population-based CP registry, the Registre de la Paralysie Cérébrale au Québec (Quebec Cerebral Palsy Registry), various antenatal, perinatal, and postnatal predictor variables, as well as current phenotype, were compared in patients with normal-appearing MRI findings and those with abnormal MRI findings. Results Of the 213 patients evaluated, 126 (60%) had MRI imaging results available and were included in our analysis. Of these 126 patients, 90 (71%; 51 males, 39 females) had abnormal findings and 36 (29%; 17 males and 19 females) had normal-appearing findings. Compared with other CP variants, normal-appearing MRI was more prevalent ( P  = .001) in dyskinetic CP (72.7%; 8 of 11) and less prevalent ( P  = .002) in spastic hemiplegic CP (10%; 4 of 40). There were no significant differences between the 2 groups ( P  > .05) in terms of the prevalence of perinatal or postnatal clinical features or clinical outcomes. Furthermore, 42% (15 of 36) of the children with normal-appearing MRI exhibited a high degree of functional disability (Gross Motor Functional Classification System IV-V), compared with 33% (30 of 90) with abnormal MRI. Conclusion No clinical features, except a higher prevalence of dyskinetic CP, was identified in the children with normal-appearing MRI. More refined imaging techniques may be needed to evaluate patients with normal-appearing MRI findings. Furthermore, genetic or functional, rather than gross structural lesions, may underlie the pathophysiology of CP in this cohort. Finally, the high proportion of substantial functional disability underscores the importance of continuous follow-up even in the absence of early structural abnormalities on imaging.
ISSN:0022-3476
1097-6833
DOI:10.1016/j.jpeds.2012.07.044