Objective:To explore the value of magnetic resonance diffusion kurtosis imaging (DKI) in the assessment of the condition and prognosis of neonatal acute bilirubin encephalopathy (ABE).Methods:A retrospective selection was made of 196 neonates with acute hyperbilirubinemia who were hospitalized in the Second Affiliated Hospital of Shantou University Medical College from June 2021 to September 2023 as the research subjects. According to the presence or absence of brain injury, they were divided into the ABE group ( n=112) and the non-ABE group ( n=84). Based on the neonatal Bilirubine-induced Neurological Dysfunction (BIND) scoring system, children in the ABE group were divided into the mild group ( n=50, score 1-3 points), the moderate group ( n=33, score 4-6 points), and the severe group ( n=29, score 7-9 points). The clinical data and DKI parameters among each group were analyzed. Univariate and multivariate analyses were used to evaluate the influencing factors of prognosis in children with ABE. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of DKI parameters for the prognosis of children with ABE. Results:The birth weight and gestational age in the ABE group were significantly lower than those in the non-ABE group, and the peak value of total bilirubin (TBIL) was significantly higher than that in the non-ABE group (all P<0.05). There was no statistically significant difference in fractional anisotropy (FA) values and mean diffusivity (MD) values among each group of children (all P>0.05). The mean kurtosis (MK) values, axial kurtosis (KA) values, and radial kurtosis (KR) values of children with ABE in the severe group were significantly higher than those in the other groups (all P<0.05). After Spearman correlation analysis, the FA value and MD value of children with ABE were not correlated with the severity of the disease (all P>0.05), while the MK value, KA value and KR value were positively correlated with the severity of the disease (all P<0.05). The patients were followed up for 12 months. Among them, 87 cases had a normal prognosis and 25 cases had a poor prognosis, including 2 cases of cerebral palsy, 5 cases of hearing loss, 4 cases of movement disorders, 12 cases of cerebral palsy combined with hearing loss, and 2 cases of movement disorders combined with hearing loss. The results of univariate analysis showed that there were statistically significant differences in birth weight, peak TBIL, BIND score, MK value, KA value, and KR value between the two groups of children with different prognoses (all P<0.05). The results of Cox multivariate regression analysis showed that birth weight, peak TBIL, BIND score, MK value, KA value, and KR value were independent influencing factors for poor prognosis in children with ABE (all P<0.05). The results of the ROC curve showed that the area under the curve and specificity of the MK value in predicting the poor prognosis of children with ABE were significantly higher than those of the KA and KR values (all P<0.05). Conclusions:The DKI parameters MK value, KA value, and KR value are sensitive indicators reflecting the severity of brain injury and predicting prognosis in children with ABE, among which the MK value has the highest predictive value.

Objective:To explore the value of magnetic resonance diffusion kurtosis imaging (DKI) in the assessment of the condition and prognosis of neonatal acute bilirubin encephalopathy (ABE).Methods:A retrospective selection was made of 196 neonates with acute hyperbilirubinemia who were hospitalized in the Second Affiliated Hospital of Shantou University Medical College from June 2021 to September 2023 as the research subjects. According to the presence or absence of brain injury, they were divided into the ABE group ( n=112) and the non-ABE group ( n=84). Based on the neonatal Bilirubine-induced Neurological Dysfunction (BIND) scoring system, children in the ABE group were divided into the mild group ( n=50, score 1-3 points), the moderate group ( n=33, score 4-6 points), and the severe group ( n=29, score 7-9 points). The clinical data and DKI parameters among each group were analyzed. Univariate and multivariate analyses were used to evaluate the influencing factors of prognosis in children with ABE. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of DKI parameters for the prognosis of children with ABE. Results:The birth weight and gestational age in the ABE group were significantly lower than those in the non-ABE group, and the peak value of total bilirubin (TBIL) was significantly higher than that in the non-ABE group (all P<0.05). There was no statistically significant difference in fractional anisotropy (FA) values and mean diffusivity (MD) values among each group of children (all P>0.05). The mean kurtosis (MK) values, axial kurtosis (KA) values, and radial kurtosis (KR) values of children with ABE in the severe group were significantly higher than those in the other groups (all P<0.05). After Spearman correlation analysis, the FA value and MD value of children with ABE were not correlated with the severity of the disease (all P>0.05), while the MK value, KA value and KR value were positively correlated with the severity of the disease (all P<0.05). The patients were followed up for 12 months. Among them, 87 cases had a normal prognosis and 25 cases had a poor prognosis, including 2 cases of cerebral palsy, 5 cases of hearing loss, 4 cases of movement disorders, 12 cases of cerebral palsy combined with hearing loss, and 2 cases of movement disorders combined with hearing loss. The results of univariate analysis showed that there were statistically significant differences in birth weight, peak TBIL, BIND score, MK value, KA value, and KR value between the two groups of children with different prognoses (all P<0.05). The results of Cox multivariate regression analysis showed that birth weight, peak TBIL, BIND score, MK value, KA value, and KR value were independent influencing factors for poor prognosis in children with ABE (all P<0.05). The results of the ROC curve showed that the area under the curve and specificity of the MK value in predicting the poor prognosis of children with ABE were significantly higher than those of the KA and KR values (all P<0.05). Conclusions:The DKI parameters MK value, KA value, and KR value are sensitive indicators reflecting the severity of brain injury and predicting prognosis in children with ABE, among which the MK value has the highest predictive value.