Transjugular intrahepatic portosystemic shunt induced short- and long-term cerebral blood flow variations in cirrhotic p
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ORIGINAL PAPER
Transjugular intrahepatic portosystemic shunt induced short- and long-term cerebral blood flow variations in cirrhotic patients: an arterial spin labeling MRI study Gang Zheng & Long Jiang Zhang & Yue Cao & Zhiying Pan & Rong Feng Qi & Ling Ni & Donghong Shi & Xinxin Fan & Guang Ming Lu Received: 28 December 2012 / Accepted: 10 March 2013 / Published online: 7 April 2013 # Springer Science+Business Media New York 2013
Abstract Short- and long-term effects of transjugular intrahepatic portosystemic shunt (TIPS) on cerebral blood flow (CBF) in patients with cirrhosis are still unclear. The purpose of this longitudinal study was to explore CBF alteration patterns in cirrhotic patients after TIPS. Thirteen cirrhotic patients (7 male, 6 female, mean age 50.0±9.3 years) underwent arterial-spin labeling (ASL) MRI 1–9 days (median 1 days) before TIPS. Follow-up MR examinations were performed about 1 week (median 6 days), 3 months (n=6), 6–9 months (n=5) and 12–18 months (n=5) after TIPS. CBF, ammonia level, Child-Pugh score, number connection test type A (NCT-A) and digit symbol test (DST) scores were converted into relative values by dividing by his/her pre-TIPS values, and then, compared via one-way analysis of variance (ANOVA). Correlations between the pre- and post-TIPS changes of relative CBF (rCBF) and the changes of relative ammonia (rAmmonia), Child-Pugh (rChild-Pugh), and NCT-A/DST (rNCT-A/rDST) scores were calculated by crossing subjects. G. Zheng : Z. Pan College of civil aviation, Nanjing University of Aeronautics and Astronautics, Nanjing, Jiangsu 210016, China
Compared with the pre-TIPS level, the global rCBF slightly increased by 10.9 % about 1 week later, then rapidly decreased by 14.2 % 3 months later, and flatly decreased by 17.2 % in 6–9 months and 18.0 % in 12–18 months following TIPS. The changes of 3-month rDST score were slightly correlated with 3-month rCBF rather than 1-week rCBF, (P < 0.1, FDR-corrected) No difference was found between the preand post-TIPS rAmmonia levels, rChild-Pugh and rNCTA/rDST scores (Post-hoc P>0.05). CBF measured at different time points after TIPS insertion showed different patterns, indicating varying longitudinal effects of TIPS on CBF. A sharp decline of rCBF was found in the 1 week to 3 months period after insertion, indicating that high event rate of hepatic encephalopathy might relate with the unadaptable CBF in patients undergoing TIPS insertion. Keywords Transjugular intrahepatic portosystemic shunt . Short and long-term effects, arteril spin labeling . Cerebral blood flow . Hepatic encephalopathy
G. Zheng : L. J. Zhang (*) : Z. Pan : R. F. Qi : L. Ni : D. Shi : G. M. Lu (*) Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu 210002, China e-mail: [email protected] e-mail: [email protected]
Abbreviations TIPS Transjugular intrahepatic portosystemic shunt ASL Arterial spin labeling NCT-A Number-connection test type A DST Digit symbol test CBF Cerebral bl
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