Brain MR Spectroscopy Markers of Encephalopathy Due to Nonalcoholic Steatohepatitis

Abstract

In hepatic encephalopathy (HE), osmotic stressors promoting brain edema result in a compensatory drop in the astrocyte metabolite myo-inositol (mI). Identifying differences between nonalcoholic steatohepatitis (NASH) with and without HE and healthy controls using proton magnetic resonance spectroscopy (MRS) and evaluating hypoalbuminemia and hyperammonemia as osmotic stressors that predict the reduction of mI allow further understanding of mechanisms that promote brain edema in HE. The aim of this study was to assess brain edema in HE using characteristic MRS markers and serum albumin. METHODS: We evaluated between group differences among 19 NASH cirrhosis without HE (Crhs-HE) (age = 63 ± 8.7), 9 NASH cirrhosis with HE (Crhs+HE) (age = 63 ± 9.2), and 16 controls (age = 57.8 ± 11.7) using 1 H MRS. Glutamine (Gln/tCr) and serum albumin were evaluated as predictors of myo-inositol (mI/tCr) using linear regression. Statistical significance was set at P < .05 with adjustment for multiple comparisons. RESULTS: Brain mI/tCr was decreased, and Gln/tCr increased in Crhs+HE compared to Crhs-HE and controls in both brain regions (P < .001 for all). Evaluated together as joint predictors, serum albumin but not Gln/tCr significantly predicted mI/tCr in GM (P = .02 and P = .2, respectively) and PWM (P = .01 and P = .1, respectively). CONCLUSION: Low mI/tCr and increased Gln/tCr were characteristics of Crhs+HE. Low serum albumin was the strongest predictor of brain osmotic stress indicated by reduced mI/tCr, with no residual independent association seen for brain Gln/tCr concentration. This suggests that hypoalbuminemia in chronic liver disease may promote brain edema in HE.

Meta-analysis and Open-source Database for In Vivo Brain Magnetic Resonance Spectroscopy in Health and Disease

“…These age ranges allowed for the greatest number of studies to be included in each of the categories while leaving a gap (e.g., 46-49 years of age) to set groups apart. There were 8 [141][142][143][144][145][146][147], 19 [148,149,[158][159][160][161][162][163][164][165][166][150][151][152][153][154][155][156][157] [183,205,[360][361][362][363][364][365][366][367][368][369]207,[370][371][372][373][374][375][376][377][378]…”

Serum albumin and white matter hyperintensities

“…In 46 patients with systemic lupus erythematosus, low serum albumin (i.e., albumin = 3.8±1.3g/dL) was associated with larger WMH lesion volume [ 52 ]. Further, CNS edema in posterior reversible encephalopathy syndrome [ 53 – 55 ] and hepatic encephalopathy [ 56 , 57 ] has been shown to relate to low serum albumin levels. By contrast, a study of 396 older (> 55 years) healthy adults in Korea showed that serum albumin as a continuous variable was associated with high cerebral β amyloid reactivity but not with WMH volume [ 58 ].…”