Quantitative assessment of neurodevelopmental maturation: a comprehensive systematic literature review of artificial intelligence-based brain age prediction in pediatric populations.

Introduction: Over the past few decades, numerous researchers have explored the application of machine learning for assessing children's neurological development. Developmental changes in the brain could be utilized to gauge the alignment of its maturation status with the child's chronological age. AI is trained to analyze changes in different modalities and estimate the brain age of subjects. Disparities between the predicted and chronological age can be viewed as a biomarker for a pathological condition. This literature review aims to illuminate research studies that have employed AI to predict children's brain age. Methods: The inclusion criteria for this study were predicting brain age via AI in healthy children up to 12 years. The search term was centered around the keywords "pediatric," "artificial intelligence," and "brain age" and was utilized in PubMed and IEEEXplore. The selected literature was then examined for information on data acquisition methods, the age range of the study population, pre-processing, methods and AI techniques utilized, the quality of the respective techniques, model explanation, and clinical applications. Results: Fifty one publications from 2012 to 2024 were included in the analysis. The primary modality of data acquisition was MRI, followed by EEG. Structural and functional MRI-based studies commonly used publicly available datasets, while EEG-based studies typically relied on self-recruitment. Many studies utilized pre-processing pipelines provided by toolkit suites, particularly in MRI-based research. The most frequently used model type was kernel-based learning algorithms, followed by convolutional neural networks. Overall, prediction accuracy may improve when multiple acquisition modalities are used, but comparing studies is challenging. In EEG, the prediction error decreases as the number of electrodes increases. Approximately one-third of the studies used explainable artificial intelligence methods to explain the model and chosen parameters. However, there is a significant clinical translation gap as no study has tested their model in a clinical routine setting. Discussion: Further research should test on external datasets and include low-quality routine images for MRI. T2-weighted MRI was underrepresented. Furthermore, different kernel types should be compared on the same dataset. Implementing modern model architectures, such as convolutional neural networks, should be the next step in EEG-based research studies.