title: Clinical and radiological impact of liver transplantation for brain in cirrhosis patients without hepatic encephalopathy.
abstract: OBJECTIVE
  To elucidate the effect of liver transplantation (LT) on brain dysfunctions in cirrhotic patients who had no clinical evidence of hepatic encephalopathy (HE), we performed a prospective study of voxel-based diffusion tensor imaging (DTI) and detailed cognitive examination.
  
  
  METHODS
  We assessed 12 consecutive patients as transplant candidates by DTI, with neurological and cognitive examinations just before and at 6 months after LT.
  
  
  RESULTS
  After LT, cirrhotic patients showed significant improvement in visual reproduction, digit symbol, digit span, Stroop test, and Trail-making test scores, suggesting recovery of frontal-temporal function. As for voxel-based DTI, increased mean diffusivity (MD) and reduced fractional anisotropy (FA) values were found before LT in the frontal and temporal lobes of cirrhotic patients. After LT, the unusual FA and MD values observed in the frontal and temporal lobes preoperatively were significantly reduced.
  
  
  CONCLUSIONS
  End-stage cirrhotic patients without clinical evidence of HE showed increased MD and decreased FA values in both frontal and temporal lobes. These parameters improved after LT, in line with cognitive function. MD and FA values might be of value as a biomarker in end-stage cirrhotic patients for investigating brain tissue dysfunctions and evaluating the efficacy of LT.
authors.affiliation: Department of Neurology, Yokkaichi Municipal Hospital, Mie, Japan.
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Ishihara
authors.forename: Mizuki
authors.initials: M
authors.lastname: Ito
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Niimi
authors.forename: Masashi
authors.initials: M
authors.lastname: Tsujimoto
authors.forename: Jo
authors.initials: J
authors.lastname: Senda
authors.forename: Yoshinari
authors.initials: Y
authors.lastname: Kawai
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Watanabe
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Ishigami
authors.forename: Takashi
authors.initials: T
authors.lastname: Ito
authors.forename: Hideya
authors.initials: H
authors.lastname: Kamei
authors.forename: Yasuharu
authors.initials: Y
authors.lastname: Onishi
authors.forename: Taro
authors.initials: T
authors.lastname: Nakamura
authors.forename: Hidemi
authors.initials: H
authors.lastname: Goto
authors.forename: Shinji
authors.initials: S
authors.lastname: Naganawa
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Kiuchi
authors.forename: Gen
authors.initials: G
authors.lastname: Sobue
mesh_terms: D000328:Adult; D000368:Aged; D016880:Anisotropy; D001921:Brain / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003071:Cognition / Q000502:physiology*; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods; D005355:Fibrosis / Q000601:surgery*; D006501:Hepatic Encephalopathy; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011859:Radiography; D016896:Treatment Outcome
keywords: ADC; ALT; AST; DTI; Diffusion tensor imaging; End-stage liver disease; FA; Fractional anisotropy; HADS; HE; Hospital Anxiety and Depression Scale; LC; LT; MD; MELD; MMSE; MRI; Mean diffusivity; Mini-Mental State Examination; Model for End-Stage Liver Disease; ROI; SPM; UPDRS; Unified Parkinson's Disease Rating Scale; VBA; Voxel-based analysis; alanine aminotransferase; apparent diffusion coefficient; aspartate aminotransferase; diffusion tensor imaging; fractional anisotropy; hepatic encephalopathy; liver cirrhosis; liver transplantation; magnetic resonance imaging; mean diffusivity; region of interest; statistical parametric mapping; voxel-based analysis