Cerebral magnetic resonance imaging reveals marked abnormalities of brain tissue density in patients with cirrhosis without overt hepatic encephalopathy

Guevara, Mónica; Baccaro, María E.; Gómez‐Anson, Beatriz; Frisoni, Giovanni B.; Testa, Cristina; Torre, Aldo; Molinuevo, José Luís; Rami, Lorena; Pereira, Gustavo; Sotil, Eva U.; Córdoba, Joan; Arroyo, Vicente; Ginès, Pere

doi:10.1016/j.jhep.2010.12.008

Cited by 88 publications

(101 citation statements)

References 26 publications

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“…Brain edema has been reported to be fatal, especially in highgrade HE, due to increased intracranial pressure. 37,38 Moreover, our findings regarding the predictive values of MD and FA on survival agree with the consensus that brain edema [9][10][11] and structural impairment 12,13 progress with advanced disease. One strength of this study is the application of an advanced machine-learning method, GAMMA, to the detection of MHErelated biomarkers.…”

Section: Results Of Validation Analysissupporting

confidence: 89%

“…The thresholds resulting in best classification result (eg, a threshold of 0.25 SD above the mean MD value or a threshold of 0.75 SD below mean FA value) were chosen and included in the following validation analyses. [7][8][9][10][11] and impaired cerebral structures [12][13][14] have been demonstrated to play an important role in the MHE mechanisms. WM edema, which could be extracellular and/or cytotoxic in origin, [8][9][10] is considered closely associated with a metabolic disorder of ammonia in the brain tissue of patients with MHE.…”

Section: Results Of Gamma Analysismentioning

confidence: 99%

“…Abnormalities in brain white matter, such as low-grade edema [7][8][9][10][11] and structural impairments, [12][13][14] have been well-revealed in MHE by MR imaging. These WM abnormalities are believed to be responsible for poor neurologic performances 12,15,16 and brain dysfunctions 17,18 in MHE and to be associated with HE development, 9,11,16 suggesting that WM imaging may be useful in characterizing potential MHE biomarkers.…”

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confidence: 99%

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Identification of Minimal Hepatic Encephalopathy in Patients with Cirrhosis Based on White Matter Imaging and Bayesian Data Mining

Chen

Yang

et al. 2014

AJNR Am J Neuroradiol

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Section: Results Of Validation Analysissupporting

confidence: 89%

Section: Results Of Gamma Analysismentioning

confidence: 99%

mentioning

confidence: 99%

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Identification of Minimal Hepatic Encephalopathy in Patients with Cirrhosis Based on White Matter Imaging and Bayesian Data Mining

Chen

Yang

et al. 2014

AJNR Am J Neuroradiol

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“…31 However, this finding appears to be contradictory to the evidence of brain atrophy from voxel-based morphometry. 33 It is possible that mild-to-moderate loss of myelin and axons is not always found in chronic HE. that proinflammatory cytokines showed positive correlation with spheric anisotropy and negative correlation with mean diffusivity in various brain regions, including the spectroscopy voxel in patients with acute liver failure.…”

Section: 6mentioning

confidence: 99%

Multimodality MR Imaging Findings of Low-Grade Brain Edema in Hepatic Encephalopathy

Zhang

Zhong

2012

AJNR Am J Neuroradiol

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SUMMARY: HE is a neuropsychiatric syndrome that develops in patients with severe liver diseases, with portosystemic shunt surgery in the form of diffuse mild brain edema. It is also associated with functional changes, such as those in attention and the DMN. MR imaging offers a range of capabilities for assessing the low-grade brain edema and its functional changes in brain affected by HE; therefore, it provides the opportunity to uncover the pathophysiologic mechanisms of HE. This article will review our current understanding of the pathophysiology of low-grade brain edema and will outline the role of structural MR imaging, MTR, DWI, DTI, and MR spectroscopy in the detection of low-grade brain edema, and the role of BOLD fMRI in the exploration of the related functional changes. A perspective of the study in this area will also be provided. ABBREVIATIONS:ALFF ϭ amplitude of low-frequency fluctuation; BOLD ϭ blood oxygen levelϪdependent; DMN ϭ default mode network; FA ϭ fractional

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“…Further evidence of the contribution of atrophy in patients with hepatic encephalopathy has recently emerged with the identification areas of atrophy throughout the cortex and white matter quantitated by VBM and correlating with the severity of encephalopathy (60). A lack of corroborative MR spectroscopy or more advanced water localisation sequences could not add further mechanistic data to this interesting observation, which requires validation from other groups.…”

Section: Volumetric Mrimentioning

confidence: 99%

Brain Imaging and Hepatic Encephalopathy

McPhail

Patel

Taylor‐Robinson

2012

Clinics in Liver Disease

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KEY WORDSHepatic encephalopathy; Brain imaging; Magnetic resonance imaging; Magnetic resonance spectroscopy, Computed tomography, Single photon emission computed tomography; Positron emission tomography. 2 SYNOPSISNovel imaging techniques are allowing hepatologists to investigate the structural and functional neuropathology of hepatic encephalopathy (HE) in greater detail but only limited techniques are applicable to the clinic. Computed tomography and magnetic resonance imaging (MRI) can rule out other diagnoses and in the case of MRI, give certain key diagnostic features in widely available sequences. While increased brain water content is a hallmark of HE, the localisation of low-grade cerebral edema, the extent of regional swelling or atrophy and the different functional characteristics of affected brain regions continue to be debated. More specialised volumetric, diffusion-tensor, magnetization transfer, functional magnetic resonance imaging and magnetic resonance spectroscopy, in conjunction with positron emission tomography continue to enrich the investigative findings in HE. Nevertheless an internationally accepted diagnostic framework that includes an objective imaging test to replace or augment psychometry remains elusive. Quantitative MRI is likely to be the best candidate to become such a test and the utility of MR and nuclear medical techniques to the clinic and results from recent research are described in this article.3

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Cerebral magnetic resonance imaging reveals marked abnormalities of brain tissue density in patients with cirrhosis without overt hepatic encephalopathy

Cited by 88 publications

References 26 publications

Identification of Minimal Hepatic Encephalopathy in Patients with Cirrhosis Based on White Matter Imaging and Bayesian Data Mining

Identification of Minimal Hepatic Encephalopathy in Patients with Cirrhosis Based on White Matter Imaging and Bayesian Data Mining

Multimodality MR Imaging Findings of Low-Grade Brain Edema in Hepatic Encephalopathy

Brain Imaging and Hepatic Encephalopathy

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