Voxel-based diffusion tensor magnetic resonance imaging evaluation of low-grade hepatic encephalopathy.
OBJECTIVE
To quantify the changes in brain water diffusivity in hepatic encephalopathy (HE) associated with cirrhosis using diffusion tensor imaging (DTI) and to correlate with neuropsychological (NP) scores.


METHODS
DTI was performed in 14 patients with low-grade HE and age/gender-comparable 16 healthy controls. Whole brain mean diffusivity (MD) and fractional anisotropy (FA) maps were calculated, normalized to common space, smoothed, and compared voxel-by-voxel between groups using analysis of covariance with age included as a covariate. The average MD and FA values were also calculated from individual subjects for selected brain regions and correlated with the neuropsychological scores.


RESULTS
Patients with HE showed increased MD in the cortical gray and white matter and the internal capsule. Less extensive brain regions with decreased FA were observed in the bilateral frontal and occipital white matter. MD values from the corpus callosum correlated inversely with several NP scores among HE patients and controls. Positive correlations were observed with FA values and cognitive scores.


CONCLUSIONS
Voxel-based DTI analysis showed widespread brain regions with increased MD values, indicating enhanced water content and decreased FA in cirrhotic patients with HE. The MD and FA values from selected regions correlated with the NP scores.
Kumar
Rajesh
R
Department of Neurobiology, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-1721, USA.
Gupta
Rakesh K
RK
Elderkin-Thompson
Virginia
V
Huda
Amir
A
Sayre
James
J
Kirsch
Claudia
C
Guze
Barry
B
Han
Steve
S
Thomas
M Albert
MA
D000328:Adult; D000368:Aged; D001929:Brain Edema / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D016022:Case-Control Studies; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006501:Hepatic Encephalopathy / Q000150:complications* / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011594:Psychometrics