Abstract：Objective To study the value of fractional anisotropy (FA) of regions of interest (ROI) on magnetic resonance diffusion tensor imaging (DTI) in bilirubin-induced neurological dysfunction in neonates. Methods A total of 91 neonates with hyperbilirubinemia who were hospitalized from January 2017 to January 2018 were enrolled. According to the peak level of total serum bilirubin, they were divided into three groups:mild/moderate increase (n=45), severe increase (n=35), and extremely severe increase (n=11). According to the presence or absence of abnormal neurological manifestations, they were divided into two groups:neurological dysfunction (n=20) and non-neurological dysfunction (n=71). Ten healthy full-term infants were enrolled as the control group. Head DTI was performed for all neonates to measure the FA values of the bilateral globus pallidus, the anterior limb of the internal capsule, the posterior limb of the internal capsule, and the cerebellar dentate nucleus. Results The extremely severe increase group had significantly lower FA values of the globus pallidus than the control, mild/moderate increase, and severe increase groups (P < 0.05). The severe increase group had significantly lower FA values of the globus pallidus than the control group (P < 0.05). The extremely severe increase group had significantly lower FA values of the posterior limb of the internal capsule than the control, mild/moderate increase, and severe increase groups (P < 0.05). The neurological dysfunction group had significantly lower FA values of the globus pallidus and the posterior limb of the internal capsule than the non-neurological dysfunction group (P < 0.05). Conclusions Serum bilirubin level combined with the changes in the DTI FA values of the globus pallidus and the posterior limb of the internal capsule can be used to predict the injury of cerebral nuclei and white matter fibers.
XU Jun,YANG Du-Jiao,HUANG Fu-Rong et al. Application of magnetic resonance diffusion tensor imaging in bilirubin-induced neurological dysfunction in neonates[J]. CJCP, 2020, 22(7): 711-715.
Stevenson DK, Watchko JF, Maisels MJ, et al. Care of the Jaundiced Neonate[M]. Europe:McGraw-Hill Education, 2012:12-16.
[2]
Bhutani VK, Wong R. Bilirubin-induced neurologic dysfunction (BIND)[J]. Semin Fetal Neonatal Med, 2015, 20(1):1.
[3]
Thomalla G, Glauche V, Koch MA, et al. Diffusion tensor imaging detects early Wallerian degeneration of the pyramidal tract after ischemic stroke[J]. Neuroimage, 2004, 22(4):1767-1774.
[4]
Baldoli C, Scola E, Della Rosa PA, et al. Maturation of preterm newborn brains:a fMRI-DTI study of auditory processing of linguistic stimuli and white matter development[J]. Brain Struct Funct, 2015, 220(6):3733-3751.
Yan R, Han D, Ren J, et al. Diagnostic value of conventional MRI combined with DTI for neonatal hyperbilirubinemia[J]. Pediatr Neonatol, 2018, 59(2):161-167.
Razek AAKA, Taman SE, El Regal ME, et al. Diffusion tensor imaging of microstructural changes in the gray and white matter in patients with Crigler-Najjar syndrome type I[J]. J Comput Assist Tomogr, 2020, 44(3):393-398.
[9]
Wisnowski JL, Panigrahy A, Painter MJ, et al. Magnetic resonance imaging of bilirubin encephalopathy:current limitations and future promise[J]. Semin Perinatol, 2014, 38(7):422-428.
[10]
Watchko JF. Kernicterus and the molecular mechanisms of bilirubin-induced CNS injury in newborns[J]. Neuromolecular Med, 2006, 8(4):513-529.
Groenendaal F, van der Grond J, de Vries LS. Cerebral metabolism in severe neonatal hyperbilirubinemia[J]. Pediatrics, 2004, 114(1):291-294.
[16]
Brites D. The evolving landscape of neurotoxicity by unconjugated bilirubin:role of glial cells and inflammation[J]. Front Pharmacol, 2012, 3:88.
[17]
Silva SL, Vaz AR, Barateiro A, et al. Features of bilirubin-induced reactive microglia:from phagocytosis to inflammation[J]. Neurobiol Dis, 2010, 40(3):663-675.
[18]
Saksena S, Jain R, Narang J, et al. Predicting survival in glioblastomas using diffusion tensor imaging metrics[J]. J Magn Reson Imaging, 2010, 32(4):788-795.
[19]
Fernandes A, Falcão AS, Silva RF, et al. MAPKs are key players in mediating cytokine release and cell death induced by unconjugated bilirubin in cultured rat cortical astrocytes[J]. Eur J Neurosci, 2007, 25(4):1058-1068.
[20]
Cece H, Abuhandan M, Cakmak A, et al. Diffusion-weighted imaging of patients with neonatal bilirubin encephalopathy[J]. Jpn J Radiol, 2013, 31(3):179-185.
[21]
Wisnowski JL, Panigrahy A, Painter MJ, et al. Magnetic resonance imaging abnormalities in advanced acute bilirubin encephalopathy highlight dentato-thalamo-cortical pathways[J]. J Pediatr, 2016, 174:260-263.
Okumura A, Hayakawa M, Tsuji T, et al. Diffusion tensor imaging in infants with basal ganglia-thalamic lesions[J]. Eur J Paediatr Neurol, 2008, 12(5):412-416.
[24]
Boskabadi H, Zakerihamidi M, Moradi A, et al. Risk factors for sensorineural hearing loss in neonatal hyperbilirubinemia[J]. Iran J Otorhinolaryngol, 2018, 30(99):195-202.
