Muhammad Ahmed Magdy Abdelhamid, Eman Abdelsameea, Enas Mohammed Korayem, Mohammed Shawky Alwarraky, Hazem Metwaly Omar
{"title":"脑功能磁共振成像在肝硬化患者肝性脑病评估中的作用。","authors":"Muhammad Ahmed Magdy Abdelhamid, Eman Abdelsameea, Enas Mohammed Korayem, Mohammed Shawky Alwarraky, Hazem Metwaly Omar","doi":"10.5114/ceh.2022.122296","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Hepatic encephalopathy (HE) is a complication of liver failure, with neurological manifestations ranging from minimal HE (MHE) to deep coma (overt HE).</p><p><strong>Aim of the study: </strong>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.</p><p><strong>Material and methods: </strong>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 <sup>1</sup>H-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.</p><p><strong>Results: </strong>The brain metabolite Glx increased with a significant correlation to HE grade (<i>p</i> = 0.001). Other brain metabolites, such as Cho and mI, decreased significantly (<i>p</i> = 0.001). Two brain metabolites (NAA and Cr) remained unchanged across all HE grades and the control group (<i>p</i> = 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.</p><p><strong>Conclusions: </strong>ADC values and <sup>1</sup>H-MRS are imaging modalities that have the potential to detect MHE and grade HE in cirrhotic patients.</p>","PeriodicalId":10281,"journal":{"name":"Clinical and Experimental Hepatology","volume":"8 4","pages":"321-329"},"PeriodicalIF":1.5000,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6d/14/CEH-8-48664.PMC9850304.pdf","citationCount":"0","resultStr":"{\"title\":\"The role of functional magnetic resonance imaging of the brain in the evaluation of hepatic encephalopathy in cirrhotic patients.\",\"authors\":\"Muhammad Ahmed Magdy Abdelhamid, Eman Abdelsameea, Enas Mohammed Korayem, Mohammed Shawky Alwarraky, Hazem Metwaly Omar\",\"doi\":\"10.5114/ceh.2022.122296\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Hepatic encephalopathy (HE) is a complication of liver failure, with neurological manifestations ranging from minimal HE (MHE) to deep coma (overt HE).</p><p><strong>Aim of the study: </strong>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.</p><p><strong>Material and methods: </strong>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 <sup>1</sup>H-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.</p><p><strong>Results: </strong>The brain metabolite Glx increased with a significant correlation to HE grade (<i>p</i> = 0.001). Other brain metabolites, such as Cho and mI, decreased significantly (<i>p</i> = 0.001). Two brain metabolites (NAA and Cr) remained unchanged across all HE grades and the control group (<i>p</i> = 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.</p><p><strong>Conclusions: </strong>ADC values and <sup>1</sup>H-MRS are imaging modalities that have the potential to detect MHE and grade HE in cirrhotic patients.</p>\",\"PeriodicalId\":10281,\"journal\":{\"name\":\"Clinical and Experimental Hepatology\",\"volume\":\"8 4\",\"pages\":\"321-329\"},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2022-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6d/14/CEH-8-48664.PMC9850304.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical and Experimental Hepatology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.5114/ceh.2022.122296\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical and Experimental Hepatology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5114/ceh.2022.122296","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
The role of functional magnetic resonance imaging of the brain in the evaluation of hepatic encephalopathy in cirrhotic patients.
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.
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.
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