title: Brain magnetic resonance spectroscopy in episodic hepatic encephalopathy.
abstract: Brain magnetic resonance (MR) study has shown metabolic abnormalities and changes in water distribution of the brain tissue that may relate to the pathogenesis of hepatic encephalopathy (HE). We designed a study to investigate the disturbances in brain water and metabolites during episodic HE using a 3-T MR scanner. Cirrhotic patients with different grades of HE underwent MR during hospitalization (n=18). The MR was repeated at 6 weeks' follow-up (n=14). The results were compared with those of a group of healthy volunteers (n=8). During episodic HE, brain diffusion-weighted imaging showed a high apparent diffusion coefficient (ADC) (12% to 14%) that decreased during follow-up (-1% to -4%). These disturbances were accompanied by high glutamine (581%), low choline (-31%), and low myo-inositol (-86%) peaks on MR spectroscopy. In overt HE, patients showed high glutamine that decreased during follow-up (-22%). In addition, these patients exhibited a rise in plasma S100 beta and enlargement of brain white-matter lesions. In conclusion, several disturbances detected by MR support the presence of impaired brain water homeostasis during episodic HE. Although astrocytes have a major role in this condition, brain edema during episodic HE may be extracellular and does not appear to be directly responsible for the development of neurologic manifestations.
authors.affiliation: Liver Unit, Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Laia
authors.initials: L
authors.lastname: Chavarria
authors.forename: Juli
authors.initials: J
authors.lastname: Alonso
authors.forename: Rita
authors.initials: R
authors.lastname: García-Martínez
authors.forename: Macarena
authors.initials: M
authors.lastname: Simón-Talero
authors.forename: Meritxell
authors.initials: M
authors.lastname: Ventura-Cots
authors.forename: Clara
authors.initials: C
authors.lastname: Ramírez
authors.forename: Maria
authors.initials: M
authors.lastname: Torrens
authors.forename: Víctor
authors.initials: V
authors.lastname: Vargas
authors.forename: Alex
authors.initials: A
authors.lastname: Rovira
authors.forename: Juan
authors.initials: J
authors.lastname: Córdoba
mesh_terms: D000368:Aged; D001921:Brain / Q000378:metabolism* / Q000473:pathology; D001923:Brain Chemistry; D001929:Brain Edema / Q000378:metabolism / Q000473:pathology; D002794:Choline / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D018698:Glutamic Acid / Q000378:metabolism*; D006501:Hepatic Encephalopathy / Q000378:metabolism* / Q000473:pathology; D006706:Homeostasis; D006801:Humans; D008103:Liver Cirrhosis / Q000378:metabolism / Q000473:pathology; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D009414:Nerve Growth Factors / Q000097:blood; D011446:Prospective Studies; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins / Q000097:blood; D014867:Water / Q000378:metabolism*
chemical_list: D009414:Nerve Growth Factors; D064568:S100 Calcium Binding Protein beta Subunit; D009418:S100 Proteins; C579160:S100B protein, human; D014867:Water; D018698:Glutamic Acid; D002794:Choline