Subclinical hepatic encephalopathy: proton MR spectroscopic abnormalities.
OBJECTIVE
To determine whether hydrogen-1 magnetic resonance (MR) spectroscopy of the brain allows detection of subclinical hepatic encephalopathy (SCHE).


METHODS
In a double-blind study, overt hepatic encephalopathy (HE) and SCHE (defined with clinical and neuropsychiatric tests) were compared by means of H-1 MR spectroscopic criteria--reduction in cerebral myo-inositol (< 2 standard deviations [SDs] from normal) and choline (< 2 SDs from normal) with or without increased cerebral glutamine (> 1 SD from normal)--in 20 patients with cirrhosis.


RESULTS
Concordance between MR spectroscopic and neuropsychiatric test results was 94% (kappa = 0.84). MR spectroscopy allowed diagnosis of SCHE in nine of nine patients (100%) and of HE in seven of eight (88%). Myo-inositol depletion alone had 80%-85% sensitivity for detection of HE and SCHE.


CONCLUSIONS
H-1 MR spectroscopy allows accurate diagnosis of SCHE, and the results suggest an important role for myo-inositol in psychomotor and visuopractic functions.
Magnetic Resonance Unit, Huntington Medical Research Institutes, Pasadena, CA 91105.
B D
BD
Ross
S
S
Jacobson
F
F
Villamil
J
J
Korula
R
R
Kreis
T
T
Ernst
T
T
Shonk
R A
RA
Moats
D000328:Adult; D001923:Brain Chemistry; D002794:Choline / Q000032:analysis; D004311:Double-Blind Method; D005260:Female; D005973:Glutamine / Q000032:analysis; D006501:Hepatic Encephalopathy / Q000175:diagnosis*; D006801:Humans; D007294:Inositol / Q000032:analysis; D008103:Liver Cirrhosis / Q000150:complications / Q000378:metabolism; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests
D005973:Glutamine; D007294:Inositol; D002794:Choline