Regional variations in cerebral proton spectroscopy in patients with chronic hepatic encephalopathy

Taylor‐Robinson, Simon D.; Sargentoni, J; Marcus, C.; Morgan, Marsha Y.; Bryant, David

doi:10.1007/bf02098881

Cited by 86 publications

(44 citation statements)

References 29 publications

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“…The reduction in myoinositol, a cerebral osmolyte, reflects the attempts of the brain to control for cell swelling 34 . All these 1 H MRS results correlate closely with the severity of encephalopathy (Fig 3) 30 . Spectral changes improve following treatment, so MRS may also prove to be a useful objective measure in disease monitoring and in gauging response to new treatment regimens.…”

Section: Cerebral Magnetic Resonance Spectroscopy Studiesmentioning

confidence: 54%

“…These spectral changes have been correlated with the underlying severity of neuropsychiatric impairment 24 . 1 H MRS studies on the brains of CHE patients show an increased glutamate resonance, reflecting ammonia detoxification in astrocytes 25,26,[30][31][32][33][34][35] , and reduced Cho and myoinositol resonances 25,26,[30][31][32][33][34][35] . The reduction in myoinositol, a cerebral osmolyte, reflects the attempts of the brain to control for cell swelling 34 .…”

Section: Cerebral Magnetic Resonance Spectroscopy Studiesmentioning

confidence: 99%

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Applications of magnetic resonance spectroscopy to chronic liver disease

Taylor-Robinson

2001

Clinical Medicine

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-In vivo magnetic resonance spectroscopy (MRS) provides a non-invasive 'window' on biochemical processes within the body. The technique is currently a research tool, but new developments in whole-body magnetic resonance imaging (MRI) may provide a role for clinical MRS in obtaining functional information at the end of a standard MRI examination. Applications of hepatic and cerebral MRS to chronic liver disease and its associated complications are specifically considered in this article. Changes in phosphorus-31 MRS with the underlying functional severity of the cirrhotic liver are discussed. These reflect increased turnover of cell membranes as the liver attempts to regenerate. Patterns of spectral abnormality in the transplanted liver are described, and also the potential use of the technique to assess the viability of the stored donor liver in the time period between organ harvesting and implantation in the transplant recipient. Metabolite abnormalities in the brain are defined in hepatic encephalopathy and in patients infected with the hepatitis C virus who have minimal hepatic inflammation. Future trends are considered: for example, the use of MRS as a non-invasive tool to assess the effectiveness of liver-directed gene therapy.

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Section: Cerebral Magnetic Resonance Spectroscopy Studiesmentioning

confidence: 54%

Section: Cerebral Magnetic Resonance Spectroscopy Studiesmentioning

confidence: 99%

Applications of magnetic resonance spectroscopy to chronic liver disease

Taylor-Robinson

2001

Clinical Medicine

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“…Indeed, the spectroscopic abnormalities associated with hepatic encephalopathy are qualitatively different with a globally reduced choline/creatine ratio. 23,24 Furthermore, there were no differences between the groups in the number connection or digit substitution tests, tools that have traditionally been used to establish the presence of minimal hepatic encephalopathy.…”

Section: Discussionmentioning

confidence: 93%

Hepatitis C and cognitive impairment in a cohort of patients with mild liver disease

et al. 2002

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Patients with chronic hepatitis C virus (HCV) infection frequently report fatigue, lassitude, depression, and a perceived inability to function effectively. Several studies have shown that patients exhibit low quality-of-life scores that are independent of disease severity. We therefore considered whether HCV infection has a direct effect on the central nervous system, resulting in cognitive and cerebral metabolite abnormalities. Twenty-seven viremic patients with biopsy-proven mild hepatitis due to HCV and 16 patients with cleared HCV were tested with a computer-based cognitive assessment battery and also completed depression, fatigue, and quality-of-life questionnaires. The HCV-infected patients were impaired on more cognitive tasks than the HCV-cleared group ( C hronic hepatitis C (HCV) infection is estimated to affect 170 million people worldwide 1 and constitutes a major public health problem. It causes a fluctuating chronic hepatitis that may progress to cirrhosis and hepatocellular carcinoma. Attempts to understand the natural history of this infection have largely focused on the viral and host factors that predict progression of liver pathology from necroinflammation and fibrosis to cirrhosis and hepatocellular carcinoma. Consequently, the decision to treat patients is normally based on an assessment of these factors, including staging of disease with a liver biopsy, 2 rather than on particular symptoms. There is, however, emerging literature suggesting that, even in the absence of clinically significant liver disease, chronic HCV infection causes a substantial reduction in quality of life 3 that improves following successful antiviral treatment. 4 These findings are in agreement with the clinical observation that patients with chronic HCV infection frequently report fatigue, lassitude, depression, and a perceived inability to function effectively. 5,6 The etiology of these symptoms is unknown. The symptoms do not appear to be associated with the degree of hepatitis, the presence of autoimmune disorders 5 or cirrhosis, 3 a history of intravenous drug usage (IVDU), 3 or the level of circulating cytokines. 7 We have previously reported cerebral metabolite abnormalities in patients with histologically proven mild HCV infection using proton magnetic resonance spectroscopy ( 1 H MRS). 8 These abnormalities are similar to the 1 H MRS changes reported in cerebral human immunodeficiency virus (HIV) infection in both cognitively impaired 9,10 and asymptomatic individuals. 11 In this study, we address the hypothesis that HCV infection can result in cerebral dysfunction, which may underlie both the neuropsychological symptoms and the 1 H MRS abnormalities described. We used a cognitive assessment battery to determine whether cognitive impairment exists in patients with histologically defined mild chronic HCV infection and 1 H MRS to determine whether cerebral metabolite abnormalities are associated with impaired cognitive function.

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“…In a recent MRS study of cirrhotic patients with hepatic encephalopathy, changes in MR spectra could be shown only for white matter [8]. Much earlier, regional variations in the obtained MRS metabolite ratios had already been pointed out, suggesting that spectral information from more than one voxel would be useful in the evaluation of patients with hepatic encephalopathy [9].…”

Section: Introductionmentioning

confidence: 99%

Quantitative multivoxel 1H MR spectroscopy of the brain in children with acute liver failure

et al. 2008

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Acute liver failure (ALF)-related encephalopathy was previously characterized by MR spectroscopy of single voxels containing both grey and white matter brain tissue. Quantitative multivoxel MRS was used here to compare grey and white matter brain tissue concentrations of glutamate/glutamine (Glx) and lactate in ALF and associate the results with other liver function parameters. Five pediatric patients with ALF-related encephalopathy and five controls, examined after successful liver transplantation, were examined by brain MRI/MRS. ALF patients had higher Glx and lactate concentrations in brain white matter than controls (Glx + 125%: P<0.01; lactate + 33%, P<0.05) and higher Glx in grey matter (Glx + 125%: P< 0.01). Within the group of ALF patients positive correlations were found between grey or white matter lactate concentration and serum ammonia (P<0.05), and negative correlations between grey or white matter Glx and venous pH (P<0.001). This is the first study presenting evidence of high Glx levels in both white and grey matter brain tissue in ALF-related encephalopathy. The elevations in CNS Glx and lactate concentrations appear to relate to hepatic detoxification (ammonia, venous pH), rather than to liver parenchymal integrity (aspartate aminotransferase, alanine aminotransferase) or biliary cholestasis (bilirubin, γ-glutamyl transpeptidase, alkaline phosphatase).

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Regional variations in cerebral proton spectroscopy in patients with chronic hepatic encephalopathy

Cited by 86 publications

References 29 publications

Applications of magnetic resonance spectroscopy to chronic liver disease

Applications of magnetic resonance spectroscopy to chronic liver disease

Hepatitis C and cognitive impairment in a cohort of patients with mild liver disease

Quantitative multivoxel 1H MR spectroscopy of the brain in children with acute liver failure

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