Voxel-based analyses of magnetization transfer imaging of the brain in hepatic encephalopathy.
OBJECTIVE
To evaluate the spatial distribution of cerebral abnormalities in cirrhotic subjects with and without hepatic encephalopathy (HE) found with magnetization transfer imaging (MTI).


METHODS
Nineteen cirrhotic patients graded from neurologically normal to HE grade 2 and 18 healthy control subjects underwent magnetic resonance imaging. They gave institutional-review-board-approved written consent. Magnetization transfer ratio (MTR) maps were generated from MTI. We tested for significant differences compared to the control group using statistical non-parametric mapping (SnPM) for a voxel-based evaluation.


RESULTS
The MTR of grey and white matter was lower in subjects with more severe HE. Changes were found in patients with cirrhosis without neurological deficits in the basal ganglia and bilateral white matter. The loss in magnetization transfer increased in severity and spatial extent in patients with overt HE. Patients with HE grade 2 showed an MTR decrease in white and grey matter: the maximum loss of magnetization transfer effect was located in the basal ganglia [SnPM (pseudo-)t = 17.98, P = 0.0001].


CONCLUSIONS
The distribution of MTR changes in HE points to an early involvement of basal ganglia and white matter in HE.
Miese
Falk-R
FR
Institute of Radiology, University Hospital Düsseldorf, MNR Clinic, Moorenstrasse 5, Düsseldorf 40225, Germany. dr.miese@gmx.de
Wittsack
Hans-Jörg
HJ
Kircheis
Gerald
G
Holstein
Arne
A
Mathys
Christian
C
Mödder
Ulrich
U
Cohnen
Mathias
M
D000328:Adult; D000368:Aged; D001479:Basal Ganglia / Q000473:pathology; D001921:Brain / Q000473:pathology*; D003627:Data Interpretation, Statistical; D005260:Female; D006501:Hepatic Encephalopathy / Q000473:pathology*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012720:Severity of Illness Index