Grey and white matter abnormalities in minimal hepatic encephalopathy: a study combining voxel-based morphometry and tra
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Grey and white matter abnormalities in minimal hepatic encephalopathy: a study combining voxel-based morphometry and tract-based spatial statistics Rongfeng Qi & Long Jiang Zhang & Jianhui Zhong & Tong Zhu & Zhiqiang Zhang & Chuanjian Xu & Gang Zheng & Guang Ming Lu
Received: 24 March 2013 / Revised: 9 June 2013 / Accepted: 13 June 2013 # European Society of Radiology 2013
Abstract Objectives Low-grade cerebral oedema is considered to be pathognomonic of minimal hepatic encephalopathy (MHE) in cirrhotic patients. The purpose of this study was to investigate both the grey matter (GM) and white matter (WM) changes in a homogeneous cohort of patients with MHE by combining voxel-based morphometry (VBM) and tractbased spatial statistics (TBSS). Methods Twenty-five MHE patients and 25 healthy controls participated in the study with three-dimensional T1 and diffusion-tensor imaging. Group differences in regional GM volume were assessed using VBM analysis while differences in fractional anisotropy (FA), mean diffusivity (MD) of WM were compared using TBSS analysis. Results VBM displayed extensively decreased GM volume in MHE, mainly located in the frontal and temporal cortices, paracentral lobule, caudate, putamen and amygdale, and increased GM volume in the thalamus. TBSS showed decreased FA in MHE patients in the corpus callosum, cingulum, internal/external capsule, corticospinal tract, superior longitudinal fasciculus and posterior corona radiata. Areas of
increased MD in MHE patients were more extensive and included, in addition to all the areas of decreased FA, the anterior corona radiata, inferior fronto-occipital fasciculus, fornix and the middle cerebellar peduncle. Conclusion The results suggest that cortical atrophy and low-grade brain oedema in WM co-exist in MHE. Key Points • Minimal hepatic encephalopathy develops before major neuropathological destruction occurs. • Cortical atrophy and low-grade brain oedema of white matter co-exist in MHE. • Blood ammonia correlates with abnormal WM indices in MHE patients. • Imaging findings could assist decisions about therapy in patients with cirrhosis. Keywords Minimal hepatic encephalopathy . Magnetic resonance imaging . Voxel-based morphometry . Tract-based spatial statistics . Diffusion tensor imaging
Introduction R. Qi : L. J. Zhang (*) : Z. Zhang : C. Xu : G. Zheng : G. M. Lu (*) Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu Province 210002, China e-mail: [email protected] e-mail: [email protected] J. Zhong Department of Biomedical Engineering, Zhejiang University, Hangzhou, Zhejiang 310027, China T. Zhu Department of Imaging Sciences, University of Rochester Medical Center, Box 648, Rochester, NY, USA
Minimal hepatic encephalopathy (MHE), the mildest form of the spectrum of HE, usually shows no recognisable clinical symptoms of HE, but produces mild cognitive, motor control and concentration attention deficits [1,
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