Brain edema dynamics in patients with overt hepatic encephalopathy A magnetic resonance imaging study.
The aim of our study was to investigate the dynamics of brain water content assessed by magnetic resonance imaging (MRI) applications in patients with cirrhosis and overt episodic hepatic encephalopathy (HE).


METHODS
Twenty-four patients with cirrhosis and overt HE, 9 healthy controls and 9 controls with cirrhosis but without HE were included. All patients underwent laboratory analysis, MRI and (1)H MRS in the first 24h after the diagnosis of encephalopathy. Five of them were studied again 5days after the resolution of HE.


RESULTS
The values of glutamine/glutamate (Glx) increased progressively (healthy controls: 1.8; cirrhotic controls: 2.4; HE: 4.4; p=0.0001). Values of myo-inositol were lower among cirrhotics than in healthy controls (healthy: 0.6; cirrhotic: 0.3; HE: 0.4; p=0.01). Patients with overt HE showed a decrease in MTR in several brain locations. A significant correlation was observed between MTR values and Glx/creatine ratios (r=-0.54; P=0.004). Five days after the resolution of HE, there were no changes in brain Glx/Cr or MTR but a significant decrease of median ADC in parietal grey matter was observed (acute HE: 121.9 vs. 5days later: 100.5; p<0.05).


CONCLUSIONS
Cirrhotic patients with overt HE have a disturbance in the brain osmolyte homeostasis, reflecting a low-grade brain edema. Shortly after the clinical resolution of the episode of HE low-grade brain edema still persists, but there is a decrease in the ADC value in the parietal grey matter, suggesting water flux from extracellular to intracellular compartments and the existence of a vasogenic brain edema.
Poveda
María-José
MJ
Unidad de Gastroenterología, Hospital General Universitario de Alicante, Alicante, Spain.
Bernabeu
Angela
A
Concepción
Luis
L
Roa
Elena
E
de Madaria
Enrique
E
Zapater
Pedro
P
Pérez-Mateo
Miguel
M
Jover
Rodrigo
R
D001834:Body Water / Q000378:metabolism; D001921:Brain / Q000378:metabolism* / Q000473:pathology; D001929:Brain Edema / Q000150:complications / Q000378:metabolism* / Q000473:pathology; D016022:Case-Control Studies; D056324:Diffusion Tensor Imaging; D005260:Female; D005355:Fibrosis / Q000150:complications / Q000378:metabolism / Q000473:pathology; D006501:Hepatic Encephalopathy / Q000150:complications / Q000378:metabolism* / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D036421:Nerve Fibers, Unmyelinated / Q000378:metabolism; D010296:Parietal Lobe / Q000378:metabolism / Q000473:pathology; D011446:Prospective Studies; D011522:Protons; D013997:Time Factors
D011522:Protons