The Study Of Routine MRI And ~1H-MRS In Children With Bilirubin Encephalopathy

Objective:To explore the application value of routine MRI and ~1H-MRS examination in bilirubin encephalopathy.Materials and methods:A total of 47 cases of severe hyperbilirubinemia were collected from October 2016 to December 2017 as cases group.The routine MRI and basal ganglia ~1H-MRS examination of the head were carried out respectively.According to the definition of Shapiro,22 cases were diagnosed as acute bilirubin encephlopathy(ABE),including 12 males and 10 females,3~19days of age,average(8.86±3.59 days),and they were included in the ABE group.The remaining 25 cases of severe hyperbilirubinemia had no obvious nervous system symptoms,and the auditory brainstem was normal,including 15 males and 10 females,2~18 days of age,average(7.72±3.84 days),which were included in the AHB group.In addition,15 full term newborns without any nervous system disease were selected(NCP).The use of MRI and ~1H-MRS examination were analyzed between the three groups N-acetylaspartate(NAA)/creatine(Cr),choline(Cho)/creatine(Cr),N-acetylaspartate(NAA)/choline(Cho)and glutamate and glutamine compounds(Glx)/creatine(Cr)ratio,and the correlation between NAA/Cr value and TSB peak value,NBNA and TSB peak value,NAA/Cr value and NBNA score in 47 cases of severe hyperbilirubinemia were analyzed.After 5~7 months,ABE and AHB group were followed up.FBE group and FHB group were numbered respectively.There were 14 cases in FBE group,including 7 males and 7 females.There were 13 cases in FHB group,including 7 males and 6 females.At the same time,13 infants of the same month age without any nervous system disease were selected as the control group(ICP).The ratio of NAA/Cr,Cho/Cr,NAA/Cho and Glx/Cr between the three groups was calculated,and the ratio were analyzed with the ratio of the acute phase.Results:In the conventional MRI,22 cases of ABE in 19 cases T1 WI showed bilateral globus pallidus and the ventral thalamus symmetrical high signal,clear edge,symmetrical shape of "eight" change,25 cases of AHB in 16 cases T1WI showed bilateral globus pallidus and the ventral thalamus symmetry a little high signal,fuzzy edge.FBE group showed symmetrical high signal on bilateral globus pallidus on T2 WI,and the edge was clear.FHB group had no obvious abnormality in routine MRI.~1H-MRS examination showed that the values of NAA/Cr and NAA/Cho in ABE group were lower than those in AHB group and NCP group(P<0.0001),and the Glx/Cr value was higher than that of AHB group and NCP group(P<0.0001).The value of NAA/Cr and NAA/Cho in FBE group were lower than that of FHB group and ICP group,and the value of NAA/Cr and NAA/Cho in FHB group were lower than that of ICP group(P<0.05),and Cho/Cr in FBE group was higher than that in FHB group and group,and the Cho/Cr value in FHB group was higher than that in ICP group(P<0.05).The Glx/Cr value in FBE group was higher than that in FHB group and ICP group(P<0.01).Compared with the FBE and ABE group,FHB and AHB group,ICP and NCP group,the value of NAA/Cr and NAA/Cho were increased,the value of Cho/Cr were all decreased and the difference was statistically significant(P<0.001),there was no significant difference in Glx/Cr value(P>0.05).NAA/Cr value has a weak negative correlation with TSB peak value(r=-0.541,P<0.001),NBNA has a weak negative correlation with TSB peak value(r=-0.405,P=0.005),and there is no significant correlation between the NAA/Cr value and NBNA score(r=0.220,P=0.138).Conclusion:BE patients have characteristics in conventional MRI,The changes in the ratio of NAA/Cr,Cho/Cr,NAA/Cho and Glx/Cr in the ~1H-MRS study,It may not noly indicate that the damage and functional changes of the neurons and axons,also suggest that the bilirubin neurotoxicity hindered the normal development of the brain tissue.~1H-MRS can provide more imaging reference for the early diagnosis and prognosis of BE at the molecular level.