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Abstract

Background and purposes

Minimal hepatic encephalopathy (MHE) has no recognizable clinical symptoms, but patients have cognitive and psychomotor deficits. Hyperammonemia along with neuroinflammation lead to microstructural changes in cerebral parenchyma. Changes at conventional imaging are detected usually at the overt clinical stage, but microstructural alterations by advanced magnetic resonance imaging techniques can be detected at an early stage.

Materials and methods

Whole brain diffusion kurtosis imaging (DKI) data acquired at 3T was analyzed to investigate microstructural parenchymal changes in 15 patients with MHE and compared with 15 age- and sex-matched controls. DKI parametric maps, namely kurtosis fractional anisotropy (kFA), mean kurtosis (MK), axial kurtosis (AK) and radial kurtosis (RK), were evaluated at 64 white matter (WM) and gray matter (GM) regions of interest (ROIs) in the whole brain and correlated with the psychometric hepatic encephalopathy score (PHES).

Results

The MHE group showed a decrease in kFA and AK across the whole brain, whereas MK and RK decreased in WM ROIs but increased in several cortical and deep GM ROIs. These alterations were consistent with brain regions involved in cognitive function. Significant moderate to strong correlations (–0.52 to –0.66; 0.56) between RK, MK and kFA kurtosis metrics and PHES were observed.

Conclusion

DKI parameters show extensive microstructural brain abnormalities in MHE with minor correlation between the severity of tissue damage and psychometric scores.

Keywords

Hepatic encephalopathy magnetic resonance imaging diffusion kurtosis imaging

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References

Acharya

Bajaj

JS.

Current management of hepatic encephalopathy. Am J Gastroenterol 2018; 113: 1600–1612.

Maldonado-Garza

Vázquez-Elizondo

Gaytán-Torres

, et al. Prevalence of minimal hepatic encephalopathy in cirrhotic patients. Ann Hepatol 2011; 10 Suppl 2: S40–44.

Dhiman

Saraswat

Sharma

, et al. Minimal hepatic encephalopathy: consensus statement of a working party of the Indian National Association for Study of the Liver. J Gastroenterol Hepatol 2010; 25: 1029–1041.

Stepanova

Mishra

Venkatesan

, et al. In-hospital mortality and economic burden associated with hepatic encephalopathy in the United States from 2005 to 2009. Clin Gastroenterol Hepatol 2012; 10: 1034–1041.e1.

Jensen

Helpern

Ramani

, et al. Diffusional kurtosis imaging: the quantification of non-Gaussian water diffusion by means of magnetic resonance imaging. Magn Reson Med 2005; 53: 1432–1440.

Dhiman

Kurmi

Thumburu

, et al. Diagnosis and prognostic significance of minimal hepatic encephalopathy in patients with cirrhosis of liver. Dig Dis Sci 2010; 55: 2381–2390.

Tabesh

Jensen

Ardekani

, et al. Estimation of tensors and tensor-derived measures in diffusional kurtosis imaging. Mag Reson Med 2011; 65: 823–836.

Ceritoglu

Oishi

, et al. Multi-contrast large deformation diffeomorphic metric mapping for diffusion tensor imaging. Neuroimage 2009; 47: 618–627.

Mishra

Sreenivasan

Zhuang

, et al. Influence of analytic techniques on comparing DTI-derived measurements in early stage Parkinson’s disease. Heliyon 2019; 5: e01481.

10.

Hunter

Lubin

Glassman

, et al. Comparing region of interest versus voxel-wise diffusion tensor imaging analytic methods in mild and moderate traumatic brain injury: a systematic review and meta-analysis. J Neurotrauma 2019; 36: 1222–1230.

11.

Shah

Neeb

Kircheis

, et al. Quantitative cerebral water content mapping in hepatic encephalopathy. Neuroimage 2008; 41: 706–717.

12.

Felipo

Hepatic encephalopathy: effects of liver failure on brain function. Nat Rev Neurosci 2013; 14: 851–858.

13.

Zhang

X-D

Zhang

L-J

S-Y

, et al. Multimodality magnetic resonance imaging in hepatic encephalopathy: an update. World J Gastroenterol 2014; 20: 11262–11272.

14.

Zhou

, et al. Dynamic susceptibility contrast-enhanced first-pass perfusion MR imaging in patients with subclinical hepatic encephalopathy. J Neuroradiol 2012; 39: 290–294.

15.

Liu

Yang

, et al. Combining arterial-spin labeling with functional magnetic resonance imaging measurement for characterizing patients with minimal hepatic encephalopathy. Hepatol Res 2017; 47: 862–871.

16.

Liu

J-Y

Ding

Lin

, et al. T2* MRI of minimal hepatic encephalopathy and cognitive correlates in vivo. J Magn Reson Imaging 2013; 37: 179–186.

17.

Liao

L-M

Zhou

L-X

H-B

, et al. Spatial working memory dysfunction in minimal hepatic encephalopathy: an ethology and BOLD-fMRI study. Brain Res 2012; 1445: 62–72.

18.

Zhang

Zhong

, et al. Disrupted thalamic resting-state functional connectivity in patients with minimal hepatic encephalopathy. Eur J Radiol 2013; 82: 850–856.

19.

Cheung

Hui

Chan

, et al. Does diffusion kurtosis imaging lead to better neural tissue characterization? A rodent brain maturation study. Neuroimage 2009; 45: 386–392.

20.

Wang

J-J

Lin

W-Y

C-S

, et al. Parkinson disease: diagnostic utility of diffusion kurtosis imaging. Radiology 2011; 261: 210–217.

21.

Gong

N-J

Wong

C-S

Chan

C-C

, et al. Correlations between microstructural alterations and severity of cognitive deficiency in Alzheimer’s disease and mild cognitive impairment: a diffusional kurtosis imaging study. Magn Reson Imaging 2013; 31: 688–694.

22.

Gómez-Ansón

Román

de Bobadilla

, et al. Alterations in cerebral white matter and neuropsychology in patients with cirrhosis and falls. PLoS One 2015; 10: e0118930.

23.

Hoeft

Barnea-Goraly

Haas

, et al. More is not always better: increased fractional anisotropy of superior longitudinal fasciculus associated with poor visuospatial abilities in Williams syndrome. J Neurosci 2007; 27: 11960–11965.

24.

J-L

Jiang

Zhang

X-D

, et al. Microstructural brain abnormalities correlate with neurocognitive dysfunction in minimal hepatic encephalopathy: a diffusion kurtosis imaging study. Neuroradiology 2019; 61: 685–694.

25.

Sun

Fan

Liu

, et al. Characterization of brain microstructural abnormalities in cirrhotic patients without overt hepatic encephalopathy using diffusion kurtosis imaging. Brain Imaging Behav 2020; 14: 627–638.

26.

Chen

H-J

Liu

P-F

Chen

Q-F

Shi

H-B.

Brain microstructural abnormalities in patients with cirrhosis without overt hepatic encephalopathy: a voxel-based diffusion kurtosis imaging study. AJR Am J Roentgenol 2017; 209: 1128–1135.

27.

Golaszewski

Langthaler

Schwenker

, et al. Abnormal cortical synaptic plasticity in minimal hepatic encephalopathy. Brain Res Bull 2016; 125: 200–204.

28.

Zhuo

Proctor

, et al. Diffusion kurtosis as an in vivo imaging marker for reactive astrogliosis in traumatic brain injury. Neuroimage 2012; 59: 467–477.

29.

Wright

Soper

Brooks

, et al. Role of aquaporin-4 in the development of brain oedema in liver failure. J Hepatol 2010; 53: 91–97.

30.

Xue

Zhang

Wen

, et al. Characterization of Alzheimer’s disease using ultra-high b-values apparent diffusion coefficient and diffusion kurtosis imaging. Aging Dis 2019; 10: 1026–1036.

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Whole brain atlas-based diffusion kurtosis imaging parameters for evaluation of minimal hepatic encephalopathy

Abstract

Background and purposes

Materials and methods

Results

Conclusion

Keywords

Get full access to this article

References

Supplementary Material