title: Regional reduction in gray and white matter volume in brains of cirrhotic patients: voxel-based analysis of MRI.
abstract: Chronic hepatic encephalopathy is a characteristically reversible neuropsychiatric disorder that occurs mainly in patients with liver cirrhosis. The brain regions critically involved in the pathophysiology of cirrhosis are not clear. Magnetic resonance imaging (MRI) with voxel-based morphometry (VBM) is a valuable tool for evaluating structural brain changes in many neurodegenerative diseases. We performed an MRI scan on 18 patients with liver cirrhosis and 16 age-matched healthy controls. We evaluated brain regional structural changes, regional differences and the relationship of these changes with the blood levels of ammonia and the results of neuropsychological tests in patients with cirrhosis. The VBM showed reduction in the volume of gray matter in the cerebellum and occipital lobe and in the volume of white matter in the cingulate, parietal, temporal, occipital lobe and precentral area in cirrhotic patients compared with controls. There were significant correlations between the volume of these regions with the plasma levels of ammonia and the results of neuropsychological tests. Voxel-based analysis of MRI revealed evidence for structural abnormalities of brain in patients with cirrhosis. Abnormal function in the above regions may account for the ammonia-mediated changes and neuropsychological deficits in hepatic encephalopathy.
authors.affiliation: Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, Edobashi 2-174, Tsu, Mie, 514-8507, Japan. motoh@clin.medic.mie-u.ac.jp
authors.forename: Motoh
authors.initials: M
authors.lastname: Iwasa
authors.forename: Rumi
authors.initials: R
authors.lastname: Mifuji-Moroka
authors.forename: Makoto
authors.initials: M
authors.lastname: Kuroda
authors.forename: Hideo
authors.initials: H
authors.lastname: Moroka
authors.forename: Naoki
authors.initials: N
authors.lastname: Fujita
authors.forename: Yoshinao
authors.initials: Y
authors.lastname: Kobayashi
authors.forename: Yukihiko
authors.initials: Y
authors.lastname: Adachi
authors.forename: Esteban C
authors.initials: EC
authors.lastname: Gabazza
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Matsuda
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Takei
mesh_terms: D000368:Aged; D000641:Ammonia / Q000097:blood; D001284:Atrophy; D001921:Brain / Q000473:pathology*; D003071:Cognition / Q000502:physiology; D005234:Fatty Liver / Q000523:psychology; D005260:Female; D006501:Hepatic Encephalopathy / Q000473:pathology*; D006509:Hepatitis B / Q000523:psychology; D006526:Hepatitis C / Q000523:psychology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008103:Liver Cirrhosis / Q000473:pathology*; D008104:Liver Cirrhosis, Alcoholic / Q000523:psychology; D008111:Liver Function Tests; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests
chemical_list: D000641:Ammonia