title: Radiographical findings in patients with liver cirrhosis and hepatic encephalopathy.
abstract: OBJECTIVE
  Hepatic encephalopathy is a common complication encountered in patients with liver cirrhosis. Hepatic encephalopathy is not reflected in the current liver transplant allocation system. Correlation was sought between hepatic encephalopathy with findings detected on radiographic imaging studies and the patient's clinical profile.
  
  
  METHODS
  A retrospective analysis was conducted of patients with cirrhosis, who presented for liver transplant evaluation in 2009 and 2010. Patients with hepatocellular carcinoma, ejection fraction less than 60% and who had a TIPS (transjugular intrahepatic portosystemic shunting) procedure or who did not complete the evaluation were excluded. Statistical analysis was performed and variables found to be significant on univariate analysis (P < 0.05) were analysed by a multivariate logistic regression model.
  
  
  RESULTS
  A total of 117 patients met the inclusion criteria and were divided into a hepatic encephalopathy group (n = 58) and a control group (n = 59). Univariate analysis found that a smaller portal vein diameter, smaller liver antero-posterior diameter, liver nodularity and use of diuretics or centrally acting medications showed significant correlation with hepatic encephalopathy. This association was confirmed for smaller portal vein, use of diuretics and centrally acting medications in the multivariate analysis.
  
  
  CONCLUSIONS
  A decrease in portal vein diameter was associated with increased risk of encephalopathy. Identifying patients with smaller portal vein diameter may warrant screening for encephalopathy by more advanced psychometric testing, and more aggressive control of constipation and other factors that may precipitate encephalopathy.
authors.affiliation: Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania (PA), USA elwir001@umn.edu.
authors.forename: Saleh
authors.initials: S
authors.lastname: Elwir
authors.affiliation: Department of Radiology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
authors.forename: Hassan
authors.initials: H
authors.lastname: Hal
authors.affiliation: Penn State Milton S. Hershey Medical Center and School of Medicine, Hershey, PA, USA.
authors.forename: Joshua
authors.initials: J
authors.lastname: Veith
authors.affiliation: Division of Gastroenterology and Hepatology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
authors.forename: Ian
authors.initials: I
authors.lastname: Schreibman
authors.affiliation: Division of Transplant Surgery, Penn State Milton S. Hershey Medical Center, Hershey PA, USA.
authors.forename: Zakiyah
authors.initials: Z
authors.lastname: Kadry
authors.affiliation: Division of Gastroenterology and Hepatology, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Riley
keywords: cirrhosis; computed tomography (CT); hepatic encephalopathy; portal vein diameter