title: Does magnetic resonance spectroscopy identify patients with minimal hepatic encephalopathy?
abstract: OBJECTIVE
  The results of a few studies suggest that magnetic resonance spectroscopy of the brain could allow detection of minimal hepatic encephalopathy. The goal of this study was to assess the ability of magnetic resonance spectroscopy to differentiate between cirrhotic patients with and without minimal hepatic encephalopathy.
  
  
  METHODS
  Localized magnetic resonance spectroscopy was performed in the basal ganglia, occipital gray matter and frontal white matter in 46 patients with liver cirrhosis without overt encephalopathy and in 45 controls. Neurological and neuropsychological examination was performed in each participant.
  
  
  RESULTS
  The patients with liver cirrhosis had a decreased ratio of myoinositol to creatine in occipital gray matter and frontal white matter (mean: 0.17 ± 0.05 vs. 0.20 ± 0.04, p = 0.01 and 0.15 ± 0.05 vs. 0.19 ± 0.04, p < 0.01, respectively) and a decreased ratio of choline to creatine in occipital gray matter (mean: 0.32 ± 0.07 vs. 0.36 ± 0.08, p = 0.03). Minimal hepatic encephalopathy was diagnosed in 7 patients. Metabolite ratios did not differ significantly between patients with and without minimal hepatic encephalopathy. Metabolite ratios did not differ significantly between patients with Child-Pugh A and those with Child-Pugh B.
  
  
  CONCLUSIONS
  Magnetic resonance spectroscopy does not allow accurate diagnosis of minimal hepatic encephalopathy. A similar profile of metabolites in the brain is observed in cirrhotic patients without cognitive impairment.
authors.affiliation: Department of Gastroenterology, Jagiellonian University Medical College, ul. OEniadeckich 5, 31-531 Kraków. michalska@su.krakow.pl
authors.forename: Irena
authors.initials: I
authors.lastname: Ciećko-Michalska
authors.forename: Tomasz
authors.initials: T
authors.lastname: Dziedzic
authors.forename: Robert
authors.initials: R
authors.lastname: Banyś
authors.forename: Magdalena
authors.initials: M
authors.lastname: Senderecka
authors.forename: Marek
authors.initials: M
authors.lastname: Binder
authors.forename: Mirosław
authors.initials: M
authors.lastname: Wyczesany
authors.forename: Jakub
authors.initials: J
authors.lastname: Szewczyk
authors.forename: Jan
authors.initials: J
authors.lastname: Wójcik
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Słowik
authors.forename: Tomasz
authors.initials: T
authors.lastname: Mach
mesh_terms: D000328:Adult; D001479:Basal Ganglia / Q000378:metabolism / Q000473:pathology; D002540:Cerebral Cortex / Q000473:pathology; D003401:Creatine / Q000378:metabolism*; D005260:Female; D005625:Frontal Lobe / Q000378:metabolism / Q000473:pathology; D006501:Hepatic Encephalopathy / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism*; D006801:Humans; D007294:Inositol / Q000378:metabolism*; D008103:Liver Cirrhosis / Q000150:complications / Q000378:metabolism; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D009778:Occipital Lobe / Q000378:metabolism / Q000473:pathology
chemical_list: D007294:Inositol; D003401:Creatine