Brain magnetic resonance spectroscopy in episodic hepatic encephalopathy
Chavarria, Laia (Hospital Universitari Vall d'Hebron)
Alonso, Juli (Hospital Universitari Vall d'Hebron)
García-Martínez, Rita (Hospital Universitari Vall d'Hebron)
Simon-Talero, Macarena (Hospital Universitari Vall d'Hebron)
Ventura-Cots, Meritxell (Hospital Universitari Vall d'Hebron)
Ramírez, Clara (Hospital Universitari Vall d'Hebron)
Torrens, Maria (Hospital Universitari Vall d'Hebron)
Vargas Blasco, Víctor (Universitat Autònoma de Barcelona. Departament de Medicina)
Rovira, Alex (Hospital Universitari Vall d'Hebron)
Córdoba Cardona, Juan (Universitat Autònoma de Barcelona. Departament de Medicina)

Fecha:	2013
Resumen:	Brain magnetic resonance (MR) study has shown metabolic abnormalities and changes in water distribution of the brain tissue that may relate to the pathogenesis of hepatic encephalopathy (HE). We designed a study to investigate the disturbances in brain water and metabolites during episodic HE using a 3-T MR scanner. Cirrhotic patients with different grades of HE underwent MR during hospitalization (n=18). The MR was repeated at 6 weeks' follow-up (n=14). The results were compared with those of a group of healthy volunteers (n=8). During episodic HE, brain diffusion-weighted imaging showed a high apparent diffusion coefficient (ADC) (12% to 14%) that decreased during follow-up (-1% to-4%). These disturbances were accompanied by high glutamine (581%), low choline (-31%), and low myo-inositol (-86%) peaks on MR spectroscopy. In overt HE, patients showed high glutamine that decreased during follow-up (-22%). In addition, these patients exhibited a rise in plasma S100 beta and enlargement of brain white-matter lesions. In conclusion, several disturbances detected by MR support the presence of impaired brain water homeostasis during episodic HE. Although astrocytes have a major role in this condition, brain edema during episodic HE may be extracellular and does not appear to be directly responsible for the development of neurologic manifestations.
Ayudas:	Instituto de Salud Carlos III PI07/0641 Instituto de Salud Carlos III PI08/0698 Ministerio de Sanidad y Consumo CM07/00109
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Lengua:	Anglès
Documento:	Article ; recerca ; Versió acceptada per publicar
Materia:	Acute hepatic encephalopathy ; Blood-brain-barrier ; Glutamine ; Leukoaraiosis ; Spectroscopy
Publicado en:	Journal of cerebral blood flow & metabolism, Vol. 33, Núm. 2 (february 2013) , p. 272-277, ISSN 1559-7016

DOI: 10.1038/jcbfm.2012.173
PMID: 23168529

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