title: Changes in cerebral blood flow after transjugular intrahepatic portosystemic shunt can help predict the development of hepatic encephalopathy: an arterial spin labeling MR study.
abstract: OBJECTIVE
  Cerebral blood flow (CBF) changes after transjugular intrahepatic portosystemic shunt (TIPS) are still unclear. Our aim is to assess the TIPS-induced CBF changes and their potential clinical significance using the arterial spin labeling (ASL) perfusion magnetic resonance imaging.
  
  
  METHODS
  Nine cirrhotic patients underwent ASL 1-8 days before and 4-7 days after TIPS. CBF was calculated at each voxel and mean CBF values were computed in the whole brain, gray matter and white matter. Changes of CBFs before and after TIPS were compared by paired t-test.
  
  
  RESULTS
  Voxel-wise results showed CBF diffusely increased in patients after TIPS, but no region with significant decrease in CBF was found, nor was any significant mean CBF difference detected in the whole brain, gray matter and white matter. Six patients out of nine showed a global CBF increase of 9-39%; one patient presented a global CBF decrease of 6%; another two showed a global CBF decrease of 16% and 31% respectively. Follow-up studies showed that the two patients with greatly decreased global CBF suffered from multiple episodes of overt hepatic encephalopathy (OHE) after TIPS and one died of OHE.
  
  
  CONCLUSIONS
  CBF derived from noninvasive ASL MRI could be used as a useful biomarker to predict the development of OHE through consecutively tracking CBF changes in patients with inserted TIPS. Increased CBFs in many cortical regions could be common effects of the TIPS procedure, while decreased global CBF following TIPS might indicate the development of OHE.
authors: Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu 210002, China.
authors: Gang
authors: G
authors: Zheng
authors: Long Jiang
authors: LJ
authors: Zhang
authors: Ze
authors: Z
authors: Wang
authors: Rong Feng
authors: RF
authors: Qi
authors: Donghong
authors: D
authors: Shi
authors: Li
authors: L
authors: Wang
authors: Xinxin
authors: X
authors: Fan
authors: Guang Ming
authors: GM
authors: Lu
mesh_terms: D000328:Adult; D001783:Blood Flow Velocity; D002536:Cerebral Arteries / Q000503:physiopathology*; D002560:Cerebrovascular Circulation; D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D008103:Liver Cirrhosis / Q000503:physiopathology* / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects*; D011379:Prognosis; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013113:Spin Labels; D016896:Treatment Outcome
chemical_list: D013113:Spin Labels