Single photon emission computed tomography and statistical parametric mapping analysis in cirrhotic patients with and without minimal hepatic encephalopathy.
OBJECTIVE
The early diagnosis and treatment of cognitive impairment in cirrhotic patients is needed to improve the patients' daily living. In this study, alterations of regional cerebral blood flow (rCBF) were evaluated in cirrhotic patients using statistical parametric mapping (SPM). The relationships between rCBF and neuropsychological test, severity of disease and biochemical data were also assessed.


METHODS
99mTc-ethyl cysteinate dimer single photon emission computed tomography was performed in 20 patients with non-alcoholic liver cirrhosis without overt hepatic encephalopathy (HE) and in 20 age-matched healthy subjects. Neuropsychological tests were performed in 16 patients; of these 7 had minimal HE. Regional CBF images were also analyzed in these groups using SPM.


RESULTS
On SPM analysis, cirrhotic patients showed regions of significant hypoperfusion in the superior and middle frontal gyri, and inferior parietal lobules compared with the control group. These areas included parts of the premotor and parietal associated areas of the cortex. Among the cirrhotic patients, those with minimal HE had regions of significant hypoperfusion in the cingulate gyri bilaterally as compared with those without minimal HE.


CONCLUSIONS
Abnormal function in the above regions may account for the relatively selective neuropsychological deficits in the cognitive status of patients with cirrhosis. These findings may be important in the identification and management of cirrhotic patients with minimal HE.
Nakagawa
Yuri
Y
Department of Radiology, Mie University School of Medicine, Tsu, Japan. yuri@clin.medic.mie-u.ac.jp
Matsumura
Kaname
K
Iwasa
Motoh
M
Kaito
Masahiko
M
Adachi
Yukihiko
Y
Takeda
Kan
K
D000368:Aged; D001921:Brain / Q000098:blood supply / Q000000981:diagnostic imaging; D001931:Brain Mapping / Q000379:methods*; D005260:Female; D005355:Fibrosis / Q000150:complications* / Q000175:diagnosis / Q000000981:diagnostic imaging*; D006501:Hepatic Encephalopathy / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000209:etiology*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D015233:Models, Statistical; D013223:Statistics as Topic; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods*