Structural and functional abnormalities of default mode network in minimal hepatic encephalopathy: a study combining DTI and fMRI.
OBJECTIVE
Live failure can cause brain edema and aberrant brain function in cirrhotic patients. In particular, decreased functional connectivity within the brain default-mode network (DMN) has been recently reported in overt hepatic encephalopathy (HE) patients. However, so far, little is known about the connectivity among the DMN in the minimal HE (MHE), the mildest form of HE. Here, we combined diffusion tensor imaging (DTI) and resting-state functional MRI (rs-fMRI) to test our hypothesis that both structural and functional connectivity within the DMN were disturbed in MHE.


METHODS
Twenty MHE patients and 20 healthy controls participated in the study. We explored the changes of structural (path length, tracts count, fractional anisotropy [FA] and mean diffusivity [MD] derived from DTI tractography) and functional (temporal correlation coefficient derived from rs-fMRI) connectivity of the DMN in MHE patients. Pearson correlation analysis was performed between the structural/functional indices and venous blood ammonia levels/neuropsychological tests scores of patients. All thresholds were set at P<0.05, Bonferroni corrected.


RESULTS
Compared to the healthy controls, MHE patients showed both decreased FA and increased MD in the tract connecting the posterior cingulate cortex/precuneus (PCC/PCUN) to left parahippocampal gyrus (PHG), and decreased functional connectivity between the PCC/PCUN and left PHG, and medial prefrontal cortex (MPFC). MD values of the tract connecting PCC/PCUN to the left PHG positively correlated to the ammonia levels, the temporal correlation coefficients between the PCC/PCUN and the MPFC showed positive correlation to the digital symbol tests scores of patients.


CONCLUSIONS
MHE patients have both disturbed structural and functional connectivity within the DMN. The decreased functional connectivity was also detected between some regions without abnormal structural connectivity, suggesting that the former may be more sensitive in detecting the early abnormalities of MHE. This study extends our understanding of the pathophysiology of MHE.
Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu Province, China.
Rongfeng
R
Qi
Qiang
Q
Xu
Long Jiang
LJ
Zhang
Jianhui
J
Zhong
Gang
G
Zheng
Shengyong
S
Wu
Zhiqiang
Z
Zhang
Wei
W
Liao
Yuan
Y
Zhong
Ling
L
Ni
Qing
Q
Jiao
Zongjun
Z
Zhang
Yijun
Y
Liu
Guangming
G
Lu
D015415:Biomarkers / Q000378:metabolism; D001921:Brain / Q000473:pathology / Q000503:physiopathology; D001931:Brain Mapping; D016022:Case-Control Studies; D003710:Demography; D056324:Diffusion Tensor Imaging / Q000379:methods*; D005260:Female; D006501:Hepatic Encephalopathy / Q000473:pathology* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009415:Nerve Net / Q000473:pathology* / Q000503:physiopathology*
D015415:Biomarkers