Subclinical hepatic encephalopathy: proton MR spectroscopic abnormalities.

Ross, Brian D.; Jacobson, Sheldon; Villamil, Federico; Korula, Jacob; Kreis, Roland; Ernst, Thomas; Shonk, Truda; Moats, Rex

doi:10.1148/radiology.193.2.7972763

Cited by 190 publications

(127 citation statements)

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“…We acknowledge, therefore, the potential confounder presented by the resonances of glycine and inositol-1-phophate on the myo-inositol resonance peak. Nevertheless, concordant with Moore and colleagues (Moore et al 1999) and on the basis of prior findings (Ross et al 1994) we believe these compounds contribute a minor (Ͻ 5%) component to the myo-inositol resonance. The proximity of mI to the water resonance may also constitute a confounder.…”

Section: Discussionsupporting

confidence: 92%

Decreased Anterior Cingulate Myo-inositol/Creatine Spectroscopy Resonance with Lithium Treatment in Children with Bipolar Disorder

Davanzo

2001

Neuropsychopharmacology

227

130

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This project was designed to compare differences in brain proton spectra between children and adolescents with bipolar disorder (BPD) and gender and age-matched normal controls, and to measure changes in myo-inositol levels following lithium therapy, utilizing in vivo proton magnetic resonance spectroscopy ( 1 H MRS). A single voxel (2x2x2 cm3) was placed in brain anterior (Tondo et al. 1998). Epidemiological data (Lewinsohn et al. 1995), suggest that the prevalence of juvenile-onset BPD may be as common as rates reported in adult populations, although estimates vary widely (Costello et al. 1996). Given the increased frequency of lithium use among children and adolescents (Ryan et al. 1999) there is a clear need to assess the effects of lithium in pediatric populations. Children may have greater lithium resistance than adults (Himmelhoch and Garfinkel 1986;Hsu 1986), and it may take up to six weeks to determine, based on clinical signs and symptoms, whether a child is responding to treatment. Biological markers of treatment response would be extremely useful, particularly in these times of limited inpatient resources. The present study measured the magnetic resonance of myo-inositol and other metabolites with 1 H MRS in pediatric subjects diagnosed with BPD, before and during lithium therapy, with baseline comparison to normal controls individually matched for age and gender. We hypothesized that lithium would have an effect on the :310-825-0469, Fax: 310-206-4446, E-mail: pdavanzo@mednet.ucla.edu Received April 13, 2000; revised August 25, 2000; accepted September 14, 2000. 360 P. Davanzo et al. N EUROPSYCHOPHARMACOLOGY 2001 -VOL . 24 , NO . 4 magnetic resonance of myo-inositol in the anterior cingulate cortex in children with BPD, as measured by in vivo proton magnetic resonance spectroscopy ( 1 H MRS). Secondarily, we postulated that a decrease in myo-inositol signal in response to lithium might be a predictor of treatment efficacy.Lithium has traditionally been the preferred treatment of the manic phase of bipolar illness in adults, children (Geller and Luby 1997), and adolescents (Strober et al. 1995) with BPD. Open-label (Hsu 1986;Carlson et al. 1992;Strober et al. 1995), and one doubleblind placebo-controlled study of adolescents with substance abuse and mania (Geller et al. 1998) suggest that juveniles with BPD may have somewhat reduced benefit from acute lithium therapy compared with adults. Nevertheless, lithium continues to be widely prescribed among children and adolescents with BPD (Geller and Luby 1997) as well as for young patients presenting with excessive irritability (Fava 1997) and extreme affective dysregulation (Vitiello and Stoff 1997).The precise neurobiological mechanisms whereby lithium reduces acute manic excitement and protects against recurrence of illness remain uncertain. It is apparent that lithium exerts an effect on intracellular second-messenger systems in which activated receptorligand complexes stimulate the turnover of inositolcontaining phospholipids (del Rio et ...

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Section: Discussionsupporting

confidence: 92%

Decreased Anterior Cingulate Myo-inositol/Creatine Spectroscopy Resonance with Lithium Treatment in Children with Bipolar Disorder

Davanzo

2001

Neuropsychopharmacology

227

130

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“…3-5) is remarkable. Observations of decreased levels of Cho/Cr in human neurologic diseases are uncommon, only previously reported in hepatic encephalopathy (HE) (35). A distinguishing feature is that HE patients have decreases in both Cho/Cr and MI/Cr.…”

Section: Ns (Cohort II and Iii)mentioning

confidence: 98%

“…In this study, MI/Cr is not decreased to below baseline levels, suggesting that distinct biological mechanisms are responsible for the MRS changes seen in these two disease states. It is possible that the changes in Cho/Cr are a result of liver dysfunction (35). Changes in diet are unlikely because our animals were clinically normal and were eating normally by 25 dpi.…”

Section: Ns (Cohort II and Iii)mentioning

confidence: 99%

In vivo ¹H MRS of brain injury and repair during acute SIV infection in the macaque model of neuroAIDS

Greco

Westmoreland

Ratai

et al. 2004

Magnetic Resonance in Med

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The metabolic response of the rhesus macaque brain during acute simian immunodeficiency virus (SIV) infection was investigated with in vivo 1 H MR spectroscopy. Fifteen rhesus macaques were studied before inoculation, and once or twice after infection. In all, 13/15 macaques had elevations of Cho/NAA at 11-13 days postinoculation (dpi); all 10 macaques measured after 13 dpi had subsequent reduction of this ratio (ANOVA, P < 10 -6 ). There were significant increases in Cho/Cr (20%, P ‫؍‬ 0.04) and MI/Cr (14%, P ‫؍‬ 0.003) at 11 dpi. At 13 dpi a 7.7% decrease (P ‫؍‬ 0.02) in NAA/Cr was observed, while Cho/Cr was no longer significantly different from baseline. At 27 dpi Cho/Cr was decreased to 18% (P ‫؍‬ 0.004) below preinoculation values, while NAA/Cr and MI/Cr were at baseline values. Absolute concentrations of Cho, MI, and NAA showed a similar time course, with no observed changes in Cr. There was a strong correlation between Cho/Cr change and plasma viral load (r s ‫؍‬ 0.79, P < 0.01). Acute SIV produces extensive metabolic abnormalities in the brain, which may reflect inflammation and neuronal injury, which are reversed with immunological control of the virus. Similar events are likely to occur in acutely HIV-infected people, and may explain the neurobehavioral symptoms associated with acute HIV infection.

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“…Para seqüência de pulso, optou-se pela técnica PRESS ("point-resolved spectroscopy"). A análise da curva espectral foi feita através de um software específico, mediante o qual se consegue localizar os picos de cada metabólito conforme a freqüência espectral correspondente 2,8,10,11,12,16,27,29,30 . Em virtude da intensa sobreposição de Glx com o pico dos radicais metileno (amino-butirato, NAA e aspartato), uma integração manual foi processada entre 2,15 e 2,45ppm para o pico de Glx, com o objetivo de representar fielmente o nível de glutamina 29 .…”

Section: Métodosunclassified

“…O diagnóstico espectroscópico da encefalopatia hepática foi estabelecido segundo os critérios de Ross 27 , ou seja, quando os pacientes apresentavam o índice MI/Cr e Cho/Cr dois desvios-padrão abaixo dos controles (MI/Cr e Cho/Cr < média -2 desvios-padrão do grupo controle) com ou sem o índice Glx/Cr um desvio-padrão acima dos controles (Glx/Cr > média + 1 desvio-padrão do grupo controle). Esses critérios foram comparados com o teste padrão (testes neuropsicométricos) para avaliação dos índices de qualidade da espectroscopia no diagnóstico da encefalopatia hepática.…”

Section: Figura 2 -Curva Espectroscópica De Indivíduo Do Grupo Controleunclassified

Detecção da encefalopatia hepática subclínica por espectroscopia cerebral

Schulz

Coelho

Matias

et al. 2007

ABCD, arq. bras. cir. dig.

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InTRODUÇÃOOs distúrbios neuropsiquiátricos associados à doença hepática crônica foram descritos, pela primeira vez, há mais de 2000 anos por Hipócrates. Apesar disto, os mecanismos precisamente envolvidos com o seu desenvolvimento permanecem incertos. A encefalopatia hepática pode ocorrer tanto na insuficiência hepática aguda quanto na crônica, mais comumente associada à disfunção hepática e derivações portossistêmicas.A prevalência da encefalopatia hepática em cirróticos varia de 30% a 84% e pode ocorrer em mais de 80% dos pacientes submetidos à derivação portocava cirúrgica . A encefalopatia é comumente subestimada em virtude da preservação das habilidades verbais dos pacientes em está-dios iniciais da doença, observando-se apenas lentificação no tempo de reação nas atividades cotidianas deixandoos inseguros, por exemplo, para dirigir automóvel. Esta forma de encefalopatia está presente na maioria dos cir- ABCDDV/532Schulz GJ, Coelho JCU, Matias JEF, Campos ACL, Schulz DD, Bertoldi GA. Detecção da encefalopatia hepática subclínica por espectroscopia cerebral.ABCD Arq Bras Cir Dig 2007; 20(2):81-6. RESUMO -Racional -A encefalopatia hepática é anormalidade neuropsiquiátrica comum em cirróticos e está associada com alterações típicas de determinados metabólitos cerebrais, como o decréscimo de mio-inositol e colina e o aumento de glutamina-glutamato, observadas na espectroscopia cerebral por ressonância magnética. Objetivo -Determinar os níveis dos metabólitos cerebrais em pacientes cirróticos para diagnóstico da encefalopatia hepática em estágios iniciais. róticos. Nas situações clinicamente aparentes, a síndrome apresenta manifestações mais severas, com alterações de comportamento, personalidade e distúrbios no nível de consciência.A literatura mostra evidências cada vez mais consistentes sobre a importância do diagnóstico e terapêutica precoce da encefalopatia hepática, preferencialmente antes do aparecimento de sinais clínicos evidentes, visando a preservação das funções cerebrais, pois alguns autores, contrariando o caráter metabólico reversível da síndrome, acreditam tratar-se de desordem neurodegenerativa lentamente progressiva .Na prática clínica rotineira, a tomografia computadorizada tem sido usada para excluir outros diagnósticos, como hematomas subdurais, que também podem causar alteração do nível de consciência em pacientes cirróticos. Até recentemente, a ressonância magnética era considerada como exame de segunda linha na investigação da encefalopatia em muitos países, assim como a espectroscopia cerebral por ressonância magnética estava confinada a instituições de pesquisa, revelando significativos avanços no entendimento dos mecanismos fisiopatológicos envolvidos. Melhorias tecnológicas no campo da ressonância

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Subclinical hepatic encephalopathy: proton MR spectroscopic abnormalities.

Abstract: H-1 MR spectroscopy allows accurate diagnosis of SCHE, and the results suggest an important role for myo-inositol in psychomotor and visuopractic functions.

Cited by 190 publications

References 0 publications

Decreased Anterior Cingulate Myo-inositol/Creatine Spectroscopy Resonance with Lithium Treatment in Children with Bipolar Disorder

Decreased Anterior Cingulate Myo-inositol/Creatine Spectroscopy Resonance with Lithium Treatment in Children with Bipolar Disorder

In vivo ¹H MRS of brain injury and repair during acute SIV infection in the macaque model of neuroAIDS

Detecção da encefalopatia hepática subclínica por espectroscopia cerebral

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Subclinical hepatic encephalopathy: proton MR spectroscopic abnormalities.

Abstract: H-1 MR spectroscopy allows accurate diagnosis of SCHE, and the results suggest an important role for myo-inositol in psychomotor and visuopractic functions.

Cited by 190 publications

References 0 publications

Decreased Anterior Cingulate Myo-inositol/Creatine Spectroscopy Resonance with Lithium Treatment in Children with Bipolar Disorder

Decreased Anterior Cingulate Myo-inositol/Creatine Spectroscopy Resonance with Lithium Treatment in Children with Bipolar Disorder

In vivo 1H MRS of brain injury and repair during acute SIV infection in the macaque model of neuroAIDS

Detecção da encefalopatia hepática subclínica por espectroscopia cerebral

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In vivo ¹H MRS of brain injury and repair during acute SIV infection in the macaque model of neuroAIDS