The role of functional magnetic resonance imaging of the brain in the evaluation of hepatic encephalopathy in cirrhotic patients.

IF 1.5 Q3 GASTROENTEROLOGY & HEPATOLOGY

Clinical and Experimental Hepatology Pub Date : 2022-12-01 DOI:10.5114/ceh.2022.122296

Muhammad Ahmed Magdy Abdelhamid, Eman Abdelsameea, Enas Mohammed Korayem, Mohammed Shawky Alwarraky, Hazem Metwaly Omar

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Abstract

Introduction: Hepatic encephalopathy (HE) is a complication of liver failure, with neurological manifestations ranging from minimal HE (MHE) to deep coma (overt HE).

Aim of the study: To demonstrate the role of functional magnetic resonance imaging (magnetic resonance spectroscopy [MRS] and apparent diffusion coefficient [ADC] value) in the assessment and grading of HE in cirrhotic patients.

Material and methods: A prospective cohort study was conducted on three groups: group I - 20 healthy controls, group II - 25 cirrhotic patients with MHE, and group III - 25 cirrhotic patients with overt HE. Each group was subjected to MRS, diffusion-weighted imaging, and neuropsychological examinations. At ¹H-MRS, the glutamate/glutamine complex (Glx), myo-inositol (mI), choline (Cho), N-acetyl aspartate (NAA), and creatine (Cr) were determined in the basal ganglia or thalamus. The metabolic ratios and ADC values of Glx/Cr, MI/Cr, Cho/Cr, and NAA/Cr were determined.

Results: The brain metabolite Glx increased with a significant correlation to HE grade (p = 0.001). Other brain metabolites, such as Cho and mI, decreased significantly (p = 0.001). Two brain metabolites (NAA and Cr) remained unchanged across all HE grades and the control group (p = 0.47 and 0.38, respectively). There was an increase in the Glx/Cr ratio and a decrease in the mI/Cr and Cho/Cr ratios. In addition, ADC values were significantly higher in cirrhotic patients with HE than in the control group.

Conclusions: ADC values and ¹H-MRS are imaging modalities that have the potential to detect MHE and grade HE in cirrhotic patients.

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脑功能磁共振成像在肝硬化患者肝性脑病评估中的作用。

肝性脑病(HE)是一种肝功能衰竭的并发症，其神经系统表现从轻度HE (MHE)到深度昏迷(显性HE)不等。研究目的:探讨功能性磁共振成像(磁共振波谱[MRS]和表观扩散系数[ADC]值)在肝硬化患者HE评估和分级中的作用。材料和方法:对三组进行了前瞻性队列研究:组I - 20名健康对照，组II - 25名MHE肝硬化患者，组III - 25名显性HE肝硬化患者。各组均行MRS、弥散加权成像、神经心理检查。1H-MRS时测定基底神经节或丘脑的谷氨酸/谷氨酰胺复合物(Glx)、肌醇(mI)、胆碱(Cho)、n -乙酰天冬氨酸(NAA)和肌酸(Cr)。测定Glx/Cr、MI/Cr、Cho/Cr和NAA/Cr的代谢率和ADC值。结果:脑代谢物Glx与HE分级显著相关(p = 0.001)。其他脑代谢物，如Cho和mI显著降低(p = 0.001)。两种脑代谢物(NAA和Cr)在所有HE等级和对照组中保持不变(p分别= 0.47和0.38)。Glx/Cr比值升高，mI/Cr和Cho/Cr比值降低。此外，肝硬化HE患者的ADC值明显高于对照组。结论:ADC值和1H-MRS是有潜力检测肝硬化患者MHE和HE分级的成像方式。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical and Experimental Hepatology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

2.80

自引率

0.00%

发文量

期刊介绍： Clinical and Experimental Hepatology – quarterly of the Polish Association for Study of Liver – is a scientific and educational, peer-reviewed journal publishing original and review papers describing clinical and basic investigations in the field of hepatology.