The Effect of Hepatic Encephalopathy, Hepatic Failure, and Portosystemic Shunt on Brain Volume of Cirrhotic Patients: A Voxel-Based Morphometry Study

Abstract

PurposeTo evaluate the effect of hepatic encephalopathy (HE), hepatic failure, and portosystemic shunt (PS) on the brain volume alteration in cirrhotic patients with MRI voxel-based morphometry (VBM).MethodsSixty cirrhotic patients (overt HE [OHE], n = 11; minimal HE [MHE], n = 19; non HE [nHE], n = 30) including 12 with pre- and post-transjugular intrahepatic portosystemic shunt (TIPS) scanning and 40 healthy controls were recruited. Neuropsychological and laboratory tests were performed in all patients. VBM was analyzed with ANOVA test among 4 groups, and t-tests for patients with different hepatic function, PS scores, and TIPS. Multiple linear regression was performed to investigate the effect of venous blood ammonia levels, Child-Pugh scores, and PS on the brain volumes in all patients.ResultsCirrhotic patients exhibited decreased volume in many areas of gray matter (GM), increased volume in thalamus, and increased whiter matter (WM) volume, with the extent of affected brain volume greater in HE patients than nHE patients. Hepatic failure also resulted in decreased GM volume. Patients with high PS scores and TIPS displayed decreased GM and increased WM volume in some regions. Post-TIPS patients displayed increased GM volume in the thalamus. Multiple covariate regression results suggested that Child-Pugh score was a major factor to affect GM volume, while PS mainly affected WM volume.ConclusionBrain structure abnormalities appeared bilaterally symmetrical in cirrhotic patients, and the impairment was more extensive in HE patients than those without HE. Increased thalamus volume was not associated with HE progression. Hepatic failure and PS altered cirrhotic patients’ brain structure.

Altered Pattern of Spontaneous Brain Activity in the Patients with End-Stage Renal Disease: A Resting-State Functional MRI Study with Regional Homogeneity Analysis

“…Furthermore, NCT-A and DST scores among the three groups showed significant difference ( Table 1 ). NCT-A and DST had been widely used to expose the neuropsychological impairments in hepatic encephalopathy [24], [28], [29]. Thus, MNE was defined using the NCT-A and DST neuropsychological tests.…”

Reduced Cingulate Gyrus Volume Associated with Enhanced Cortisol Awakening Response in Young Healthy Adults Reporting Childhood Trauma

“…All T1-weighted high-resolution anatomical data were preprocessed by using the previous method [26], [27]. The analyses were performed using the Statistical Parametric Mapping 8 (SPM8) software (Wellcome Department of Imaging Neuroscience, University College London, UK; http://www.fil.ion.ucl.ac.uk/spm) in a Matlab environment.…”

The Direct Contribution of Astrocytes and Microglia to the Pathogenesis of Hepatic Encephalopathy

“…65 During chronic liver disease it was thought that cerebral edema was not a pathological characteristic of HE, as increased intracranial pressure is rare in this patient population. In addition, there is a decrease in grey matter and an increase in white matter in patients with cirrhosis, 66 and low grade cerebral edema has been observed in patients with cirrhosis and minimal HE. 67 In 4-week BDL rats, there is an increase of AQP-4 expression in the cortex, hippocampus, striatum and cerebellum that was associated with increased water content in all brain regions.…”