title: Voxel-based analyses of magnetization transfer imaging of the brain in hepatic encephalopathy.
abstract: 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.
authors.affiliation: Institute of Radiology, University Hospital Düsseldorf, MNR Clinic, Moorenstrasse 5, Düsseldorf 40225, Germany. dr.miese@gmx.de
authors.forename: Falk-R
authors.initials: FR
authors.lastname: Miese
authors.forename: Hans-Jörg
authors.initials: HJ
authors.lastname: Wittsack
authors.forename: Gerald
authors.initials: G
authors.lastname: Kircheis
authors.forename: Arne
authors.initials: A
authors.lastname: Holstein
authors.forename: Christian
authors.initials: C
authors.lastname: Mathys
authors.forename: Ulrich
authors.initials: U
authors.lastname: Mödder
authors.forename: Mathias
authors.initials: M
authors.lastname: Cohnen
mesh_terms: 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