Minimal hepatic encephalopathy in children with liver cirrhosis: diffusion-weighted MR imaging and proton MR spectroscopy of the brain

Neuroradiology. 2014 Oct;56(10):885-91. doi: 10.1007/s00234-014-1409-0. Epub 2014 Jul 25.

Abstract

Introduction: 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).

Conclusion: DWI and 1H-MRS are imaging modalities that can detect minHE in children with liver cirrhosis and correlate well with parameters of NPT.

Publication types

  • Controlled Clinical Trial

MeSH terms

  • Adolescent
  • Child
  • Choline / metabolism
  • Creatine / metabolism
  • Diffusion Magnetic Resonance Imaging*
  • Female
  • Glutamic Acid / metabolism
  • Hepatic Encephalopathy / diagnosis*
  • Hepatic Encephalopathy / etiology
  • Hepatic Encephalopathy / metabolism
  • Humans
  • Inositol / metabolism
  • Liver Cirrhosis / complications*
  • Liver Cirrhosis / metabolism
  • Male
  • Prospective Studies
  • Proton Magnetic Resonance Spectroscopy*

Substances

  • Glutamic Acid
  • Inositol
  • Creatine
  • Choline