Cerebral magnetic resonance imaging reveals marked abnormalities of brain tissue density in patients with cirrhosis without overt hepatic encephalopathy

Mónica Guevara, María E. Baccaro, Beatriz Gómez-Ansón, Giovanni Frisoni, Cristina Testa, Aldo Torre, José Luis Molinuevo, Lorena Rami, Gustavo Pereira, Eva Urtasun Sotil, Joan Córdoba, Vicente Arroyo, Pere Gins

Research output: Contribution to journalArticle

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Abstract

Background & Aims: We applied advanced magnetic resonance imaging and Voxed based Morphometry analysis to assess brain tissue density in patients with cirrhosis. Methods: Forty eight patients with cirrhosis without overt hepatic encephalopathy (17 Child A, 13 Child B, and 18 Child C) and 51 healthy subjects were matched for age and sex. Seventeen patients had history of overt hepatic encephalopathy, eight of them had minimal hepatic encephalopathy at inclusion, 10 other patients had minimal hepatic encephalopathy at inclusion but without history of previous overt hepatic encephalopathy, and 21 patients had none of these features. Results: Patients with cirrhosis presented decreased brain density in many areas of the grey and white matter. The extension and size of the affected areas were greater in patients with alcoholic cirrhosis than in those with post-hepatitic cirrhosis and correlated directly with the degree of liver failure and cerebral dysfunction (as estimated by neuropsychological tests and the antecedent of overt hepatic encephalopathy). Twelve additional patients with cirrhosis who underwent liver transplantation were explored after a median time of 11 months (7-50 months) after liver transplant. At the time of liver transplantation, three patients belonged to class A of the Child-Pugh classification, five to class B and four to class C. Compared to healthy subjects, liver transplant patients showed areas of reduced brain density in both grey and white matter. Conclusions: These results indicate that loss of brain tissue density is common in cirrhosis, progresses during the course of the disease, is greater in patients with history of hepatic encephalopathy, and persists after liver transplantation. The significance, physiopathology, and clinical relevance of this abnormality cannot be ascertained from the current study.

Original languageEnglish
Pages (from-to)564-573
Number of pages10
JournalJournal of Hepatology
Volume55
Issue number3
DOIs
Publication statusPublished - Sep 2011

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Hepatic Encephalopathy
Fibrosis
Magnetic Resonance Imaging
Brain
Liver Transplantation
Healthy Volunteers
Transplants
Alcoholic Liver Cirrhosis
Neuropsychological Tests
Liver
Liver Failure

Keywords

  • Cirrhosis
  • Hepatic encephalopathy
  • Magnetic resonance images
  • Voxel-based Morphometry

ASJC Scopus subject areas

  • Hepatology

Cite this

Cerebral magnetic resonance imaging reveals marked abnormalities of brain tissue density in patients with cirrhosis without overt hepatic encephalopathy. / Guevara, Mónica; Baccaro, María E.; Gómez-Ansón, Beatriz; Frisoni, Giovanni; Testa, Cristina; Torre, Aldo; Molinuevo, José Luis; Rami, Lorena; Pereira, Gustavo; Sotil, Eva Urtasun; Córdoba, Joan; Arroyo, Vicente; Gins, Pere.

In: Journal of Hepatology, Vol. 55, No. 3, 09.2011, p. 564-573.

Research output: Contribution to journalArticle

Guevara, M, Baccaro, ME, Gómez-Ansón, B, Frisoni, G, Testa, C, Torre, A, Molinuevo, JL, Rami, L, Pereira, G, Sotil, EU, Córdoba, J, Arroyo, V & Gins, P 2011, 'Cerebral magnetic resonance imaging reveals marked abnormalities of brain tissue density in patients with cirrhosis without overt hepatic encephalopathy', Journal of Hepatology, vol. 55, no. 3, pp. 564-573. https://doi.org/10.1016/j.jhep.2010.12.008
Guevara, Mónica ; Baccaro, María E. ; Gómez-Ansón, Beatriz ; Frisoni, Giovanni ; Testa, Cristina ; Torre, Aldo ; Molinuevo, José Luis ; Rami, Lorena ; Pereira, Gustavo ; Sotil, Eva Urtasun ; Córdoba, Joan ; Arroyo, Vicente ; Gins, Pere. / Cerebral magnetic resonance imaging reveals marked abnormalities of brain tissue density in patients with cirrhosis without overt hepatic encephalopathy. In: Journal of Hepatology. 2011 ; Vol. 55, No. 3. pp. 564-573.
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AU - Guevara, Mónica

AU - Baccaro, María E.

AU - Gómez-Ansón, Beatriz

AU - Frisoni, Giovanni

AU - Testa, Cristina

AU - Torre, Aldo

AU - Molinuevo, José Luis

AU - Rami, Lorena

AU - Pereira, Gustavo

AU - Sotil, Eva Urtasun

AU - Córdoba, Joan

AU - Arroyo, Vicente

AU - Gins, Pere

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N2 - Background & Aims: We applied advanced magnetic resonance imaging and Voxed based Morphometry analysis to assess brain tissue density in patients with cirrhosis. Methods: Forty eight patients with cirrhosis without overt hepatic encephalopathy (17 Child A, 13 Child B, and 18 Child C) and 51 healthy subjects were matched for age and sex. Seventeen patients had history of overt hepatic encephalopathy, eight of them had minimal hepatic encephalopathy at inclusion, 10 other patients had minimal hepatic encephalopathy at inclusion but without history of previous overt hepatic encephalopathy, and 21 patients had none of these features. Results: Patients with cirrhosis presented decreased brain density in many areas of the grey and white matter. The extension and size of the affected areas were greater in patients with alcoholic cirrhosis than in those with post-hepatitic cirrhosis and correlated directly with the degree of liver failure and cerebral dysfunction (as estimated by neuropsychological tests and the antecedent of overt hepatic encephalopathy). Twelve additional patients with cirrhosis who underwent liver transplantation were explored after a median time of 11 months (7-50 months) after liver transplant. At the time of liver transplantation, three patients belonged to class A of the Child-Pugh classification, five to class B and four to class C. Compared to healthy subjects, liver transplant patients showed areas of reduced brain density in both grey and white matter. Conclusions: These results indicate that loss of brain tissue density is common in cirrhosis, progresses during the course of the disease, is greater in patients with history of hepatic encephalopathy, and persists after liver transplantation. The significance, physiopathology, and clinical relevance of this abnormality cannot be ascertained from the current study.

AB - Background & Aims: We applied advanced magnetic resonance imaging and Voxed based Morphometry analysis to assess brain tissue density in patients with cirrhosis. Methods: Forty eight patients with cirrhosis without overt hepatic encephalopathy (17 Child A, 13 Child B, and 18 Child C) and 51 healthy subjects were matched for age and sex. Seventeen patients had history of overt hepatic encephalopathy, eight of them had minimal hepatic encephalopathy at inclusion, 10 other patients had minimal hepatic encephalopathy at inclusion but without history of previous overt hepatic encephalopathy, and 21 patients had none of these features. Results: Patients with cirrhosis presented decreased brain density in many areas of the grey and white matter. The extension and size of the affected areas were greater in patients with alcoholic cirrhosis than in those with post-hepatitic cirrhosis and correlated directly with the degree of liver failure and cerebral dysfunction (as estimated by neuropsychological tests and the antecedent of overt hepatic encephalopathy). Twelve additional patients with cirrhosis who underwent liver transplantation were explored after a median time of 11 months (7-50 months) after liver transplant. At the time of liver transplantation, three patients belonged to class A of the Child-Pugh classification, five to class B and four to class C. Compared to healthy subjects, liver transplant patients showed areas of reduced brain density in both grey and white matter. Conclusions: These results indicate that loss of brain tissue density is common in cirrhosis, progresses during the course of the disease, is greater in patients with history of hepatic encephalopathy, and persists after liver transplantation. The significance, physiopathology, and clinical relevance of this abnormality cannot be ascertained from the current study.

KW - Cirrhosis

KW - Hepatic encephalopathy

KW - Magnetic resonance images

KW - Voxel-based Morphometry

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