Diffusion MRI shows increased water apparent diffusion coefficient in the brains of cirrhotics

Abstract

Brain water apparent diffusion coefficient is increased in patients with chronic liver disease and may be useful in monitoring patients with hepatic encephalopathy.

Decreased white matter lesion volume and improved cognitive function after liver transplantation

“…26 A cross-sectional diffusion-weighted MRI study obtained in patients with cirrhosis showed a significant increase in brain water diffusivity, with highest diffusivity in patients with the most severe encephalopathy. 27 According to the basic understanding of diffusivity, 26 these findings likely reflect water accumulation in the extracellular compartment. A plausible explanation for the development of diffuse extracellular edema is increased blood-brain barrier permeability in particularly vulnerable areas, probably induced by age-related microvascular changes.…”

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

“…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.…”

“…[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. 7,8,10,30 Although the neuropathologic mechanism of decreased FA is not well-understood in the setting of cirrhosis, one possible explanation is demyelination.…”

“…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. 7,8,10,30 Although the neuropathologic mechanism of decreased FA is not well-understood in the setting of cirrhosis, one possible explanation is demyelination. Osmotic demyelination (due to inappropriate correction of hyponatremia 31 ) has been noted in cirrhosis.…”

“…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.…”