The etiology of cirrhosis is a strong determinant of brain reserve: A multimodal magnetic resonance imaging study.
Poor brain reserve in alcoholic cirrhosis could worsen insight regarding disease severity and increase the patients' vulnerability toward further deterioration. The aim of this study was to analyze brain reserve in abstinent alcoholic cirrhotic (Alc) patients compared to nonalcoholic cirrhotic (Nalc) patients in the context of hepatic encephalopathy (HE) and to evaluate relative change in brain reserve between groups over time and before and after elective transjugular intrahepatic portosystemic shunt (TIPS) placement. The cross-sectional study included 46 Alc and 102 Nalc outpatients with or without HE. Cognitive tests were followed by magnetic resonance imaging (MRI), including proton magnetic resonance spectroscopy (1 H-MRS), diffusion tensor imaging, and T1-weighted imaging. The prospective study included 1H-MRS on a subset of 10 patients before and after TIPS placement. Another subset of 26 patients underwent (1) H-MRS at least 1 year apart. For the cross-sectional study, Alc patients were worse on cognitive tests than Nalc patients. MRI results suggest a greater effect of hyperammonemia, brain edema, and significantly higher cortical damage in Alc as compared to Nalc patients. The effect of HE status on cognitive tests and brain reserve was more marked in the Nalc than in the Alc group. For the TIPS study, Nalc patients showed a greater adverse relative change after TIPS compared to the Alc group. At 1-year follow-up, both groups remained stable between the 2 visits. However, Alc patients continued to show poor brain reserve compared to Nalc patients over time. In conclusion, Alc patients, despite abstinence, have a poor brain reserve, whereas Nalc patients have a greater potential for brain reserve deterioration after HE and TIPS. Information regarding the brain reserve in cirrhosis could assist medical teams to refine their communication and monitoring strategies for different etiologies.
Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA.
Vishwadeep
V
Ahluwalia
Department of Psychiatry, McGuire Veterans Administration Medical Center, Virginia Commonwealth University, Richmond, VA.
James B
JB
Wade
Department of Psychiatry, McGuire Veterans Administration Medical Center, Virginia Commonwealth University, Richmond, VA.
F Gerard
FG
Moeller
Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA.
Melanie B
MB
White
Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA.
Ariel B
AB
Unser
Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA.
Edith A
EA
Gavis
Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA.
Richard K
RK
Sterling
Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA.
R Todd
RT
Stravitz
Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA.
Arun J
AJ
Sanyal
Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA.
Mohammad S
MS
Siddiqui
Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA.
Puneet
P
Puri
Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA.
Velimir
V
Luketic
Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA.
Douglas M
DM
Heuman
Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA.
Michael
M
Fuchs
Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA.
Scott
S
Matherly
Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University, Richmond, VA.
Jasmohan S
JS
Bajaj
D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology*; D003071:Cognition; D003430:Cross-Sectional Studies; D038524:Diffusion Magnetic Resonance Imaging; D056324:Diffusion Tensor Imaging; D017558:Elective Surgical Procedures; D005260:Female; D006501:Hepatic Encephalopathy / Q000209:etiology / Q000473:pathology* / Q000523:psychology / Q000601:surgery; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D008104:Liver Cirrhosis, Alcoholic / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D009483:Neuropsychological Tests; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011237:Predictive Value of Tests; D011446:Prospective Studies; D066244:Proton Magnetic Resonance Spectroscopy; D011594:Psychometrics; D012307:Risk Factors; D016896:Treatment Outcome; D014768:Virginia; D055815:Young Adult