title: Minimal hepatic encephalopathy in children with liver cirrhosis: diffusion-weighted MR imaging and proton MR spectroscopy of the brain.
abstract: BACKGROUND
  The aim of this work was to detect minimal hepatic encephalopathy (minHE) in children with diffusion-weighted MR imaging (DWI) and proton magnetic resonance spectroscopy (1H-MRS) of the brain.
  
  
  METHODS
  Prospective study conducted upon 30 consecutive children (age range 6-16 years, 21 boys and 9 girls) with liver cirrhosis and 15 age- and sex-matched healthy control children. Patients with minHE (n = 17) and with no minHE (n = 13) groups and control group underwent DWI, 1H-MRS, and neuropsychological tests (NPTs). The glutamate or glutamine (Glx), myoinositol (mI), choline (Cho), and creatine (Cr) at the right ganglionic region were determined at 1H-MRS. The apparent diffusion coefficient (ADC) value and metabolic ratios of Glx/Cr, mI/Cr, and Cho/Cr were calculated.
  
  
  RESULTS
  There was elevated ADC value and Glx/Cr and decreased mI/CI and Ch/Cr in patients with minHE compared to no minHE and control group. There was significant difference between minHE, no minHE, and control group in the ADC value (P = 0.001 for all groups), GLx/Cr (P = 0.001 for all groups), mI/Cr (P = 0.004, 0.001, and 0.001, respectively), Ch/Cr (P = 0.001 for all groups), and full-scale IQ of NPT (P = 0.001, 0.001, and 0.143, respectively). The NPT of minHE had negative correlation with ADC value (r = -0.872, P = 0.001) and GLx/Cr (r = -0.812, P = 0.001) and positive correlation with mI/Cr (r = 0.732, P = 0.001).
  
  
  CONCLUSIONS
  DWI and 1H-MRS are imaging modalities that can detect minHE in children with liver cirrhosis and correlate well with parameters of NPT.
authors: Department of Diagnostic Radiology, Mansoura Faculty of Medicine, Mansoura University Hospital, Mansoura, 13551, Egypt, arazek@mans.edu.eg.
authors: Ahmed Abdel Khalek Abdel
authors: AA
authors: Razek
authors: Ahmed
authors: A
authors: Abdalla
authors: Amany
authors: A
authors: Ezzat
authors: Ahmed
authors: A
authors: Megahed
authors: Tarek
authors: T
authors: Barakat
mesh_terms: D000293:Adolescent; D002648:Child; D002794:Choline / Q000378:metabolism; D003401:Creatine / Q000378:metabolism; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D018698:Glutamic Acid / Q000378:metabolism; D006501:Hepatic Encephalopathy / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism; D006801:Humans; D007294:Inositol / Q000378:metabolism; D008103:Liver Cirrhosis / Q000150:complications* / Q000378:metabolism; D008297:Male; D011446:Prospective Studies; D066244:Proton Magnetic Resonance Spectroscopy
chemical_list: D018698:Glutamic Acid; D007294:Inositol; D003401:Creatine; D002794:Choline