title: Connectivity of default-mode network is associated with cerebral edema in hepatic encephalopathy.
abstract: Cerebral edema, a well-known feature of acute liver disease, can occur in cirrhotic patients regardless of hepatic encephalopathy (HE) and adversely affect prognosis. This study characterized and correlated functional HE abnormalities in the brain to cerebral edema using resting-state functional magnetic resonance imaging (rs-fMRI) and diffusion tensor imaging (DTI). Forty-one cirrhotic patients (16 without HE, 14 minimal HE, 11 overt HE) and 32 healthy controls were assessed. The HE grade in cirrhotic patients was evaluated by the West Haven criteria and neuro-psychological examinations. Functional connectivity correlation coefficient (fc-CC) of the default mode network (DMN) was determined by rs-fMRI, while the corresponding mean diffusivity (MD) was obtained from DTI. Correlations among inter-cortical fc-CC, DTI indices, Cognitive Ability Screening Instrument scores, and laboratory tests were also analyzed. Results showed that gradual reductions of HE-related consciousness levels, from "without HE" or "minimal HE" to "overt HE", correlated with decreased anterior-posterior fc-CC in DMN [F(4.415), p = 0.000)]. The MD values from regions with anterior-posterior fc-CC differences in DMN revealed significant differences between the overt HE group and other groups. Increased MD in this network was inversely associated with decreased fc-CC in DMN and linearly correlated with poor cognitive performance. In conclusion, cerebral edema can be linked to altered cerebral temporal architecture that modifies both within- and between-network connectivity in HE. Reduced fc-CC in DMN is associated with behavior and consciousness deterioration. Through appropriate targets, rs-fMRI technology may provide relevant supplemental information for monitoring HE and serve as a new biomarker for clinical diagnosis.
authors.affiliation: Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: Wei-Che
authors.initials: WC
authors.lastname: Lin
authors.forename: Tun-Wei
authors.initials: TW
authors.lastname: Hsu
authors.forename: Chao-Long
authors.initials: CL
authors.lastname: Chen
authors.forename: Changwei W
authors.initials: CW
authors.lastname: Wu
authors.forename: Cheng-Hsien
authors.initials: CH
authors.lastname: Lu
authors.forename: Hsiu-Ling
authors.initials: HL
authors.lastname: Chen
authors.forename: Shau-Hsuan
authors.initials: SH
authors.lastname: Li
authors.forename: Pin-Yang
authors.initials: PY
authors.lastname: Yeh
authors.forename: Yu-Fan
authors.initials: YF
authors.lastname: Cheng
authors.forename: Ching-Po
authors.initials: CP
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001929:Brain Edema / Q000209:etiology / Q000473:pathology*; D056324:Diffusion Tensor Imaging; D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology / Q000473:pathology*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009415:Nerve Net / Q000473:pathology*; D009483:Neuropsychological Tests; D013624:Taiwan