title: Brain regional homogeneity changes following transjugular intrahepatic portosystemic shunt in cirrhotic patients support cerebral adaptability theory--a resting-state functional MRI study.
abstract: OBJECTIVE
  The exact neuro-pathophysiological effect of transjugular intrahepatic portosystemic shunt (TIPS) on brain function remains unclear. The purpose of this study was to investigate the longitudinal brain activity changes in cirrhotic patients with TIPS insertion using resting-state functional MRI (fMRI) with regional homogeneity (ReHo) method.
  
  
  METHODS
  Fifteen cirrhotic patients without overt hepatic encephalopathy (OHE) planned for TIPS procedure and 15 age- and gender-matched healthy controls were included in this study. Eleven of the 15 patients underwent repeated fMRI examinations at median 7-day following TIPS, 8 patients in median 3-month, and 7 patients in median 1-year follow-up duration, respectively. Regional homogeneity was calculated by the Kendall's coefficient of concordance (KCC) and compared between patients before TIPS and healthy controls with two-sample t test as well as pre-and post-TIPS patients with paired t test. Correlations between the pre- and post-TIPS changes of ReHo and the changes of venous blood ammonia level and number connection test type A (NCT-A)/digit symbol test (DST) scores were calculated by crossing subjects.
  
  
  RESULTS
  Compared with healthy controls, 15 cirrhotic patients before TIPS procedure showed decreased ReHo in the bilateral frontal, parietal, temporal and occipital lobes and increased ReHo in the bilateral caudate. Compared with the pre-TIPS patients, 11 post-TIPS patients in the median 7-day follow-up examinations demonstrated decreased ReHo in the medial frontal gyrus (MFG), superior parietal gyrus (SPG), middle/superior temporal gyrus (M/STG), anterior cingulate cortex (ACC), caudate, and increased ReHo in the insula. Eight post-TIPS patients in the median 3-month follow-up examinations showed widespread decreased ReHo in the bilateral frontal and parietal lobes, ACC, caudate, and increased ReHo in the insula and precuneus/cuneus. In the median 1-year follow-up studies, seven post-TIPS patients displayed decreased ReHo in the bilateral frontal and parietal lobes, ACC, supplementary motor area (SMA), posterior cingulate cortex (PCC), and increased ReHo in the caudate and insula (P<0.05, Alphasim corrected). The changes of ReHo values in bilateral IPL, MFG, caudate and SMA were correlated with changes of DST scores during the median 3-month follow-up (all P<0.05).
  
  
  CONCLUSIONS
  The TIPS implantation had a persistent effect on brain function in cirrhotic patients including both predominant impairment and compensation mechanisms, with the most significant alterations in the median 3-month period after TIPS. The ReHo analysis may be potentially valuable for uncovering the mechanism of TIPS' effects on brain function.
authors.affiliation: Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China.
authors.forename: Ling
authors.initials: L
authors.lastname: Ni
authors.affiliation: Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China.
authors.forename: Rongfeng
authors.initials: R
authors.lastname: Qi
authors.affiliation: Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China. Electronic address: kevinzhlj@163.com.
authors.forename: Long Jiang
authors.initials: LJ
authors.lastname: Zhang
authors.affiliation: Department of Biomedical Engineering, Zhejiang University, Hangzhou, Zhejiang 310027, China.
authors.forename: Jianhui
authors.initials: J
authors.lastname: Zhong
authors.affiliation: Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Zheng
authors.affiliation: Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China.
authors.forename: Xingjiang
authors.initials: X
authors.lastname: Wu
authors.affiliation: Department of General Surgery, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China.
authors.forename: Xinxin
authors.initials: X
authors.lastname: Fan
authors.affiliation: Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing 210002, China. Electronic address: cjr.luguangming@vip.163.com.
authors.forename: Guang Ming
authors.initials: GM
authors.lastname: Lu
mesh_terms: D000222:Adaptation, Physiological; D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping / Q000379:methods; D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology* / Q000503:physiopathology*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009415:Nerve Net / Q000503:physiopathology; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000009:adverse effects*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
keywords: Cirrhosis; Functional magnetic resonance imaging; Hepatic encephalopathy; Regional homogeneity; Resting-state; Transjugular intrahepatic portosystemic shunt