Brain MR imaging and 1H-MR spectroscopy changes in patients with extrahepatic portal vein obstruction from early childhood to adulthood.
OBJECTIVE
MR imaging and (1)H-MR spectroscopy changes are well reported in cirrhotic patients, whereas they are inadequately reported in EHPVO. The aim of this study was to investigate age-related changes in brain MR imaging and metabolite profile in EHPVO with and without MHE and to explore any correlation of imaging and (1)H-MR spectroscopy parameters with blood ammonia.


METHODS
Sixty-three patients with EHPVO (children, 7-12 years [n = 22], adolescents, 13-18 years [n = 15] and adults, 19-41 years [n = 26]) and 47 healthy age/sex-matched volunteers were studied. Neuropsychological tests, MR imaging, (1)H-MR spectroscopy, and blood ammonia estimation were performed in all subjects.


RESULTS
Of 63 EHPVO patients, 25 (40%) who had MHE showed significantly increased MD, Glx, and blood ammonia in all 3 age groups; however, myo-inositol was significantly lower only in adults when compared with controls. MD positively correlated with blood ammonia and Glx in all age groups. Brain choline levels were normal in all patients with different age groups.


CONCLUSIONS
Increases in brain MD, Glx, and blood ammonia were associated with MHE in all age groups. Normal brain choline in EHPVO signifies healthy liver and may serve as a diagnostic marker for its differentiation from cirrhosis-induced encephalopathy. Significant decrease of myo-inositol in adults is probably due to cellular osmoregulation secondary to long-standing hyperammonemia.
Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India.
S K
SK
Yadav
S
S
Saksena
Anshu
A
Srivastava
Arti
A
Srivastava
V A
VA
Saraswat
M A
MA
Thomas
R K S
RK
Rathore
Rakesh K
RK
Gupta
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000641:Ammonia / Q000097:blood; D001479:Basal Ganglia / Q000378:metabolism / Q000473:pathology; D002648:Child; D005260:Female; D006501:Hepatic Encephalopathy / Q000378:metabolism* / Q000473:pathology*; D006801:Humans; D022124:Hyperammonemia / Q000378:metabolism* / Q000473:pathology*; D007294:Inositol / Q000378:metabolism; D008103:Liver Cirrhosis / Q000378:metabolism / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D009483:Neuropsychological Tests; D011169:Portal Vein / Q000473:pathology; D011522:Protons; D014882:Water-Electrolyte Balance / Q000502:physiology; D055815:Young Adult
D011522:Protons; D007294:Inositol; D000641:Ammonia