Magnetic Resonance Image of Neonatal Acute Bilirubin Encephalopathy: A Diffusion Kurtosis Imaging Study

Abstract

Background and Objective: The abnormal T1-weighted imaging of MRI can be used to characterize neonatal acute bilirubin encephalopathy (ABE) in newborns, but has limited use in evaluating the severity and prognosis of ABE. This study aims to assess the value of diffusion kurtosis imaging (DKI) in detecting ABE and understanding its pathogenesis.Method: Seventy-six newborns with hyperbilirubinemia were grouped into three groups (mild group, moderate group, and severe group) based on serum bilirubin levels. All the patients underwent conventional MRI and DKI serial, as well as 40 healthy full-term infants (control group). The regions of interest (ROIs) were the bilateral globus pallidus, dorsal thalamus, frontal lobe, auditory radiation, superior temporal gyrus, substantia nigra, hippocampus, putamen, and inferior olivary nucleus. The values of mean diffusivity (MD), axial kurtosis (AK), radial kurtosis (RK), and mean kurtosis (MK), and fractional anisotropy (FA), radial diffusivity (RD), and axis diffusivity (AD) of the ROIs were evaluated. All newborns were followed up and evaluated using the Denver Development Screening Test (DDST). According to the follow-up results, the patients were divided into the normal group, the suspicious abnormal group, and the abnormal group.Result: Compared with the control group, significant differences were observed with the increased MK of dorsal thalamus, AD of globus pallidus in the moderate group, and increased RD, MK, AK, and RK value of globus pallidus, dorsal thalamus, auditory radiation, superior temporal gyrus, and hippocampus in the severe group. The peak value of total serum bilirubin was moderately correlated with the MK of globus pallidus, dorsal thalamus, and auditory radiation and was positively correlated with the other kurtosis value. Out of 76 patients, 40 finished the DDST, and only 9 patients showed an abnormality. Compared with the normal group, the AK value of inferior olivary nucleus showed significant differences (p < 0.05) in the suspicious abnormal group, and the MK of globus pallidus, temporal gyrus, and auditory radiation; RK of globus pallidus, dorsal thalamus, and auditory radiation; and MD of globus pallidus showed significant differences (p < 0.05) in the abnormal group.Conclusion: DKI can reflect the subtle structural changes of neonatal ABE, and MK is a sensitive indicator to indicate the severity of brain damage.

Establishment and Evaluation of Influencing Factors and Risk Prediction Model of Severe Neonatal Hyperbilirubinemia Complicated with Acute Bilirubin Encephalopathy

“…Hyperbilirubinemia is one of the common neonatal diseases, which can be divided into mild, moderate, and severe according to the bilirubin level. Most neonates can return to normal within a short period of time after symptomatic care [ 13 ]. However, our country's large population, unbalanced distribution of medical and health resources, and lack of family members' awareness of ABE have led to the development of ABE in some neonates with severe hyperbilirubinemia.…”

Evaluation of crossed cerebellar diaschisis after cerebral infarction in MCAO rats based on DKI

“…Cerebral ischaemia and hypoxia affect ATP synthesis, decrease the cerebral microcirculation, and impair the activity of Na+‐K+‐ATPase, leading to increase of cell membrane permeability and flow of a large amount of Na + and water molecules into cells, which was accompanied by Ca 2+ and Cl − influx. Cells will fall into a hyperosmotic state, and intercellular spaces become smaller 31 . The diffusion of water molecules is limited, the ADC, MD and FA values decrease, while the MK value increases.…”

“…Cells will fall into a hyperosmotic state, and intercellular spaces become smaller. 31 The diffusion of water molecules is limited, the ADC, MD and FA values decrease, while the MK value increases. With the aggravation of ischaemia and hypoxia, neurons continue to necrosis, cell membranes rupture and vascular permeability increases.…”

Associations between Neonatal Jaundice and Autism Spectrum Disorder or Attention Deficit Hyperactivity Disorder: Nationwide Population Based Cohort Study

“…Unbound bilirubin deposits in the hippocampus, which is the same area of neuroimaging study in ASD/ADHD [40]. Besides, bilirubin can modulate growth factors which regulate the neurogenesis and synaptic function in neural development [41], impair long-term synaptic plasticity in the hippocampus [42], and decrease density of dendritic spines and synapses [43].…”