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.

Highlights

  • Hyperbilirubinemia is one of the most common neonatal disorders [1]

  • This study aims to assess the value of diffusion kurtosis imaging (DKI) in detecting Acute bilirubin encephalopathy (ABE) and understanding its pathogenesis

  • DKI can reflect the subtle structural changes of neonatal ABE, and mean kurtosis (MK) is a sensitive indicator to indicate the severity of brain damage

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Summary

Introduction

Hyperbilirubinemia is one of the most common neonatal disorders [1]. High levels of indirect free bilirubin, which is not bound to albumin in the blood, can impact the central nervous system by crossing the blood–brain barrier and precipitating in the brain cells [2]. Acute bilirubin encephalopathy (ABE), which is characterized by a progressive disorder of neural behavior, can result in death or lifelong neurodevelopmental disabilities [3,4,5]. Increased signal intensity on T1-weighted images of the globus pallidus, subthalamic nuclei, and hippocampus is the characteristic MRI findings at the acute stage of bilirubin encephalopathy [10]. In chronic bilirubin encephalopathy, T2weighted hyperintense imaging of the globus pallidus and subthalamic nuclei is more accurate than T1-weighted imaging [11, 12]. 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

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