Population‐based studies of brain imaging patterns in cerebral palsy

Aim The aim of this study was to review the distribution of neuroimaging findings from a contemporary population cohort of individuals with cerebral palsy (CP) and to facilitate standardization of imaging classification. Method Publications from 1995 to 2012 reporting imaging findings in population cohorts were selected through a literature search, and review of the titles, s, and content of studies. Relevant data were extracted, including unpublished data from Victoria, Australia. The proportions for each imaging pattern were tabulated, and heterogeneity was assessed for all individuals with CP, and for subgroups based on gestational age, CP subtype, and Gross Motor Function Classification System level. Results Studies from three geographic regions met the inclusion criteria for individuals with CP, and two additional studies reported on specific CP subtypes. Brain abnormalities were observed in 86% of scans, but were observed least often in children with ataxia (24–57%). White matter injury was the most common imaging pattern (19–45%), although the proportions showed high heterogeneity. Additional patterns were grey matter injury (21%), focal vascular insults (10%), malformations (11%), and miscellaneous findings (4–22%). Interpretation This review suggests areas where further dialogue will facilitate progress towards standardization of neuroimaging classification. Standardization will enable future collaborations aimed at exploring the relationships among magnetic resonance imaging patterns, risk factors, and clinical outcomes, and, ultimately, lead to better understanding of causal pathways and opportunities for prevention. What this paper adds Of children with CP, 86% had abnormalities detected on brain imaging. Normal neuroimaging was particularly associated with ataxic CP. Malformations and focal vascular insults were consistently reported between population studies but white matter injury showed high heterogeneity. This review suggests ways to improve consistency in the classification of neuroimaging in CP. The first review to present imaging findings in CP by GMFCS level.