…either ultrasound or MRI, or by EEG, or neurological examination, or even during follow-up by screening for disabilities.
That title is from a recently published editorial (Fayed N, et al. Quality of life cannot be predicted from a brain scan. Dev Med Child Neurol. 2020;62(4):412) which is available full-text open access, and which includes this pearl:
Even though levels of cognitive and motor problems can often be based on magnetic resonance imaging results, abnormal electroencephalogram ﬁndings, and a neonate’s hospital course, the happiness and acceptance a child will achieve in their families and communities cannot.
I actually would argue that none of those 3 methods can be used to identify cognitive or motor problems with any reliable degree of certainty. The PPV of disabling cerebral palsy, for example, based on white matter injury shown on the MRI, is LESS THAN 50%.
Even if pre-discharge imagery were perfectly predictive of impairments, which is far from being the case, being impaired does not imply a poor quality of life. There is very little correlation between a life of quality and whether or not an individual is impaired. As these authors note:
disability severity has little relationship to life quality. Instead, emotional well-being, peer interactions, parental adaptation, and community support are much more powerful predictors of whether a child is likely to grow up to have a good life. When conveying a prognosis of severe disability and its consequences to child and family, the solution is a simple one. Refrain from confounding the concept of a good QoL with the prognosis of cognitive or physical disability.
We perform many investigations to try and predict the outcomes of our patients, sometimes with the idea that we should change the intensity of our care based on the results.
When you state the issue as clearly as these authors did in the title of their article it becomes almost self-evident; of course you cannot predict quality of life by looking at the brain. And if you cannot, then why are we doing so many scans?
I so agree!