White matter abnormalities correlate with neurocognitive performance in patients with HBV-related cirrhosis

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.…”

“…16 In addition, positron-emission tomography studies have indicated that an altered glial cell state, an important cause of MHE, occurs in the frontal WM and in the corpus callosum. 36 The frontal and parietal WM and corpus callosum (particularly the anterior part) are the regions most commonly reported to demonstrate increased water content 11 or diffusivity 9,10,12,15,16 and decreased FA. 15 When patients with cirrhosis in the intermediate state are excluded, Sugimoto et al 16 reported 70%-90% sensitivity and 85%-90% specificity in classification of MHE and NHE, based on a frontal or parietal WM ADC metric.…”

“…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.…”

“…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. Of WM imaging techniques, diffusion tensor imaging, measuring the appropriate metrics such as mean diffusivity (MD), reflecting water movement across cell membranes, and fractional anisotropy (FA), reflecting microstructural in-tegrity of WM, is demonstrated to reveal the neuropathologic processes of MHE through group-level comparison.…”

“…Of WM imaging techniques, diffusion tensor imaging, measuring the appropriate metrics such as mean diffusivity (MD), reflecting water movement across cell membranes, and fractional anisotropy (FA), reflecting microstructural in-tegrity of WM, is demonstrated to reveal the neuropathologic processes of MHE through group-level comparison. 8,9,12,14,15,17 To date, however, there is no study using DTI-derived feature maps to discriminate patients with and without MHE in cirrhosis at the individual level; this discrimination remains an important question for clinicians. 6,19 The only related study is the report of Sugimoto et al, 16 which used a DWI-based metric (apparent diffusion coefficient) instead of DTI to classify patients with or without MHE, but in which patients in the intermediate state were excluded; this method obviously results in inadequate assessment.…”