title: Magnetic Resonance Spectroscopy for Evaluating Portal-Systemic Encephalopathy in Patients with Chronic Hepatic Schistosomiasis Japonicum.
abstract: Portal-systemic encephalopathy (PSE) is classified as type B hepatic encephalopathy. Portal-systemic shunting rather than liver dysfunction is the main cause of PSE in chronic hepatic schistosomiasis japonicum (HSJ) patients. Owing to lack of detectable evidence of intrinsic liver disease, chronic HSJ patients with PSE are frequently clinically undetected or misdiagnosed, especially chronic HSJ patients with covert PSE (subclinical encephalopathy). In this study, we investigated whether magnetic resonance spectroscopy (MRS) could be a useful tool for diagnosing PSE in chronic HSJ patients. Magnetic resonance (MR) T1-weighted imaging, diffusion-weighted imaging, and MRS were performed in 41 chronic HSJ patients with suspected PSE and in 21 age-matched controls. The T1 signal intensity index (T1SI) and apparent diffusion coefficient (ADC) value were obtained in the Globus pallidus. Liver function was also investigated via serum ammonia and liver function tests. Higher T1SI and ADC values, increased lactate and glutamine levels, and decreased myo-inositol were found in the bilateral Globus pallidus in chronic HSJ patients with PSE. No significantly abnormal serum ammonia or liver function tests were observed in chronic HSJ patients with PSE. On the basis of these findings, we propose a diagnostic procedure for PSE in chronic HSJ patients. This study reveals that MRS can be useful for diagnosing PSE in chronic HSJ patients.
authors.affiliation: Department of Radiology, Jinshan Hospital & Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Dermatology, Jinshan Hospital & Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Lihong
authors.initials: L
authors.lastname: Mei
authors.affiliation: Department of Radiology, Jinshan Hospital & Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Jinwei
authors.initials: J
authors.lastname: Qiang
authors.affiliation: Department of Radiology, Jinshan Hospital & Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Shuai
authors.initials: S
authors.lastname: Ju
authors.affiliation: Department of Radiology, Jinshan Hospital & Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Shuhui
authors.initials: S
authors.lastname: Zhao
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000641:Ammonia / Q000097:blood; D001921:Brain / Q000000981:diagnostic imaging / Q000378:metabolism; D002908:Chronic Disease; D005260:Female; D005917:Globus Pallidus; D005973:Glutamine / Q000097:blood; D006501:Hepatic Encephalopathy / Q000150:complications* / Q000000981:diagnostic imaging* / Q000378:metabolism; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D008107:Liver Diseases; D008111:Liver Function Tests; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D012554:Schistosomiasis japonica / Q000150:complications* / Q000000981:diagnostic imaging / Q000378:metabolism / Q000469:parasitology
chemical_list: D005973:Glutamine; D019344:Lactic Acid; D000641:Ammonia