title: Cerebral magnetic resonance imaging reveals marked abnormalities of brain tissue density in patients with cirrhosis without overt hepatic encephalopathy.
abstract: OBJECTIVE
  We applied advanced magnetic resonance imaging and Voxed based Morphometry analysis to assess brain tissue density in patients with cirrhosis.
  
  
  METHODS
  Forty eight patients with cirrhosis without overt hepatic encephalopathy (17 Child A, 13 Child B, and 18 Child C) and 51 healthy subjects were matched for age and sex. Seventeen patients had history of overt hepatic encephalopathy, eight of them had minimal hepatic encephalopathy at inclusion, 10 other patients had minimal hepatic encephalopathy at inclusion but without history of previous overt hepatic encephalopathy, and 21 patients had none of these features.
  
  
  RESULTS
  Patients with cirrhosis presented decreased brain density in many areas of the grey and white matter. The extension and size of the affected areas were greater in patients with alcoholic cirrhosis than in those with post-hepatitic cirrhosis and correlated directly with the degree of liver failure and cerebral dysfunction (as estimated by neuropsychological tests and the antecedent of overt hepatic encephalopathy). Twelve additional patients with cirrhosis who underwent liver transplantation were explored after a median time of 11months (7-50months) after liver transplant. At the time of liver transplantation, three patients belonged to class A of the Child-Pugh classification, five to class B and four to class C. Compared to healthy subjects, liver transplant patients showed areas of reduced brain density in both grey and white matter.
  
  
  CONCLUSIONS
  These results indicate that loss of brain tissue density is common in cirrhosis, progresses during the course of the disease, is greater in patients with history of hepatic encephalopathy, and persists after liver transplantation. The significance, physiopathology, and clinical relevance of this abnormality cannot be ascertained from the current study.
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Barcelona, Catalunya, Spain; CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain. Electronic address: mguevara@clinic.ub.es.
authors.forename: Mónica
authors.initials: M
authors.lastname: Guevara
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Barcelona, Catalunya, Spain; CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
authors.forename: María E
authors.initials: ME
authors.lastname: Baccaro
authors.affiliation: Radiology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: Beatriz
authors.initials: B
authors.lastname: Gómez-Ansón
authors.affiliation: Centro S. Giovanni di Dio-Fatebenefratelli Brescia, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Frisoni
authors.affiliation: Centro S. Giovanni di Dio-Fatebenefratelli Brescia, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Testa
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Barcelona, Catalunya, Spain; CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
authors.forename: Aldo
authors.initials: A
authors.lastname: Torre
authors.affiliation: Neurology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: Molinuevo
authors.affiliation: Neurology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain.
authors.forename: Lorena
authors.initials: L
authors.lastname: Rami
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Barcelona, Catalunya, Spain; CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Pereira
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Barcelona, Catalunya, Spain; CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
authors.forename: Eva Urtasun
authors.initials: EU
authors.lastname: Sotil
authors.affiliation: CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain; Hospital de Valle de Hebrón, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Córdoba
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Barcelona, Catalunya, Spain; CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Arroyo
authors.affiliation: Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Barcelona, Catalunya, Spain; CIBER de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain.
authors.forename: Pere
authors.initials: P
authors.lastname: Ginès
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000503:physiopathology*; D005260:Female; D006501:Hepatic Encephalopathy / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology*; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000473:pathology / Q000821:virology; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications / Q000473:pathology; D016031:Liver Transplantation / Q000502:physiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged