title: Decreased white matter lesion volume and improved cognitive function after liver transplantation.
abstract: Focal T2-weighted white matter lesions (WML) on brain magnetic resonance imaging (MRI), mimicking those seen in cerebrovascular small-vessel disease described in patients with persistent hepatic encephalopathy, decreased in volume with the improvement of hepatic encephalopathy. This outcome has been interpreted as a decrease in the edema that it is proposed to be involved in the pathogenesis of hepatic encephalopathy. We designed a study to further investigate potential changes in focal WML in the brains of patients with cirrhosis following liver transplantation and to study the relationship between these changes and overall cognitive function. We used MRI to measure the volume of supratentorial focal WML and a neuropsychological examination to assess cognitive function before and after liver transplantation in 27 patients with cirrhosis without signs of overt hepatic encephalopathy. Baseline MRI identified focal T2-weighted lesions in 19 patients (70.3%). The presence of WML was associated with older age but not with vascular risk factors, severity of liver function, or psychometric tests. A significant reduction in lesion volume was observed after liver transplantation (from a median of 1.306 cm(3) to 0.671 cm(3), P = 0.001). This decrease correlated with an improvement in an index of global cognitive function (r = -0.663; P < 0.001). This evolution indicates that lesion volume is partially related to a reversible type of tissue damage, which is compatible with brain edema.
  
  
  CONCLUSIONS
  Focal WML probably induced by age-related microvascular injury can decrease their volume with liver transplantation. The associated improvement of cognitive function supports a relationship between brain edema and minimal hepatic encephalopathy.
authors.affiliation: Unitat de Ressonància Magnètica (I.D.I), Departament de Radiologia, Hospital Universitari Vall d'Hebron, Barcelona, Spain. alex.rovira@idi-cat.org
authors.forename: Alex
authors.initials: A
authors.lastname: Rovira
authors.forename: Beatriz
authors.initials: B
authors.lastname: Mínguez
authors.forename: F Xavier
authors.initials: FX
authors.lastname: Aymerich
authors.forename: Carlos
authors.initials: C
authors.lastname: Jacas
authors.forename: Elena
authors.initials: E
authors.lastname: Huerga
authors.forename: Juan
authors.initials: J
authors.lastname: Córdoba
authors.forename: Juli
authors.initials: J
authors.lastname: Alonso
mesh_terms: D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology; D003071:Cognition; D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology / Q000473:pathology / Q000523:psychology*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D016896:Treatment Outcome