title: Transjugular intrahepatic portosystemic shunt induced short- and long-term cerebral blood flow variations in cirrhotic patients: an arterial spin labeling MRI study.
abstract: Short- and long-term effects of transjugular intrahepatic portosystemic shunt (TIPS) on cerebral blood flow (CBF) in patients with cirrhosis are still unclear. The purpose of this longitudinal study was to explore CBF alteration patterns in cirrhotic patients after TIPS. Thirteen cirrhotic patients (7 male, 6 female, mean age 50.0 ± 9.3 years) underwent arterial-spin labeling (ASL) MRI 1-9 days (median 1 days) before TIPS. Follow-up MR examinations were performed about 1 week (median 6 days), 3 months (n = 6), 6-9 months (n = 5) and 12-18 months (n = 5) after TIPS. CBF, ammonia level, Child-Pugh score, number connection test type A (NCT-A) and digit symbol test (DST) scores were converted into relative values by dividing by his/her pre-TIPS values, and then, compared via one-way analysis of variance (ANOVA). Correlations between the pre- and post-TIPS changes of relative CBF (rCBF) and the changes of relative ammonia (rAmmonia), Child-Pugh (rChild-Pugh), and NCT-A/DST (rNCT-A/rDST) scores were calculated by crossing subjects. Compared with the pre-TIPS level, the global rCBF slightly increased by 10.9 % about 1 week later, then rapidly decreased by 14.2 % 3 months later, and flatly decreased by 17.2 % in 6-9 months and 18.0 % in 12-18 months following TIPS. The changes of 3-month rDST score were slightly correlated with 3-month rCBF rather than 1-week rCBF, (P < 0.1, FDR-corrected) No difference was found between the pre- and post-TIPS rAmmonia levels, rChild-Pugh and rNCT-A/rDST scores (Post-hoc P > 0.05). CBF measured at different time points after TIPS insertion showed different patterns, indicating varying longitudinal effects of TIPS on CBF. A sharp decline of rCBF was found in the 1 week to 3 months period after insertion, indicating that high event rate of hepatic encephalopathy might relate with the unadaptable CBF in patients undergoing TIPS insertion.
authors.affiliation: College of civil aviation, Nanjing University of Aeronautics and Astronautics, Nanjing, Jiangsu, 210016, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Zheng
authors.forename: Long Jiang
authors.initials: LJ
authors.lastname: Zhang
authors.forename: Yue
authors.initials: Y
authors.lastname: Cao
authors.forename: Zhiying
authors.initials: Z
authors.lastname: Pan
authors.forename: Rong Feng
authors.initials: RF
authors.lastname: Qi
authors.forename: Ling
authors.initials: L
authors.lastname: Ni
authors.forename: Donghong
authors.initials: D
authors.lastname: Shi
authors.forename: Xinxin
authors.initials: X
authors.lastname: Fan
authors.forename: Guang Ming
authors.initials: GM
authors.lastname: Lu
mesh_terms: D000641:Ammonia / Q000097:blood; D000704:Analysis of Variance; D002536:Cerebral Arteries / Q000473:pathology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000503:physiopathology* / Q000601:surgery*; D008111:Liver Function Tests; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects; D011597:Psychomotor Performance / Q000502:physiology; D012959:Socioeconomic Factors; D013113:Spin Labels
chemical_list: D013113:Spin Labels; D000641:Ammonia
references.citation: Brain Res. 1997 Aug 8;765(1):169-72
references.pmid: 9310409
references.citation: Radiology. 2012 Nov;265(2):528-36
references.pmid: 22996745
references.citation: Neuroimage. 2002 Jan;15(1):273-89
references.pmid: 11771995
references.citation: Gut. 1969 Nov;10(11):894-7
references.pmid: 5358580
references.citation: J Hepatol. 2011 Feb;54(2):265-71
references.pmid: 21067839
references.citation: NMR Biomed. 2006 Dec;19(8):1043-54
references.pmid: 16948114
references.citation: Liver Transpl. 2001 Mar;7(3):274-8
references.pmid: 11244172
references.citation: Metab Brain Dis. 2004 Dec;19(3-4):177-94
references.pmid: 15554414
references.citation: Magn Reson Imaging. 2012 Dec;30(10):1409-15
references.pmid: 22789842
references.citation: Metab Brain Dis. 2010 Mar;25(1):57-63
references.pmid: 20182779
references.citation: Eur J Radiol. 2012 Dec;81(12):3851-6
references.pmid: 22832118
references.citation: Neuroimage. 2002 Mar;15(3):488-500
references.pmid: 11848692
references.citation: Magn Reson Imaging. 2008 Feb;26(2):261-9
references.pmid: 17826940
references.citation: Lancet. 1991 May 25;337(8752):1250-3
references.pmid: 1674063
references.citation: Hepatology. 1998 Nov;28(5):1215-25
references.pmid: 9794904
references.citation: Ital J Neurol Sci. 1989 Aug;10(4):415-21
references.pmid: 2793414
references.citation: Gut. 2008 Feb;57(2):268-78
references.pmid: 18192456
references.citation: Clin Gastroenterol Hepatol. 2011 Nov;9(11):1001-3
references.pmid: 21806953
references.citation: Hepatology. 2010 Jun;51(6):2236-7
references.pmid: 20229586
references.citation: J Magn Reson Imaging. 2005 Dec;22(6):723-6
references.pmid: 16261574
references.citation: Gastroenterology. 2009 Mar;136(3):863-71
references.pmid: 19041869
references.citation: Hepatology. 1999 Oct;30(4):876-80
references.pmid: 10498637
references.citation: Radiology. 2012 Jul;264(1):187-95
references.pmid: 22509052
references.citation: J Neuroradiol. 2012 Dec;39(5):290-4
references.pmid: 22047891
references.citation: Hepatology. 2005 Feb;41(2):386-400
references.pmid: 15660434
references.citation: Hepatology. 2013 Jan;57(1):258-65
references.pmid: 22886493
references.citation: J Vasc Interv Radiol. 2001 Nov;12(11):1279-84
references.pmid: 11698626
references.citation: Magn Reson Imaging. 2005 Jan;23(1):75-81
references.pmid: 15733791