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Cerebral blood flow measured by arterial-spin labeling MRI: a useful biomarker for characterization of minimal hepatic encephalopathy in patients with cirrhosis.

Abstract

PURPOSE

To investigate the role of arterial-spin labeling (ASL) MRI to non-invasively characterize the patterns of cerebral blood flow (CBF) changes in cirrhotic patients and to assess the potential of ASL MRI to characterize minimal hepatic encephalopathy (MHE).

MATERIALS AND METHODS

This study was approved by the local ethics committee, and written informed consent was obtained from all participants. Thirty six cirrhosis patients without overt hepatic encephalopathy (16 MHE patients and 20 non hepatic encephalopathy (non-HE) patients) and 25 controls underwent ASL MRI, and CBF was measured for each subject. One-way ANOCOVA test with age and gender as covariences was used to compare CBF difference among three groups, and post hoc analysis was performed between each two groups. Region-based correlation analysis was applied between Child-Pugh score, venous blood ammonia level, neuropsychological tests and CBF values in cirrhosis patients. Receiver operator characteristic (ROC) analysis was used for assessing CBF measurements in ASL MRI to differentiate MHE from non-HE patients.

RESULTS

The gray matter CBF of MHE patients (71.09 ± 11.88 mL min(-1)100g(-1)) was significantly higher than that of non-HE patients (55.28 ± 12.30 mL min(-1)100g(-1), P<0.01) and controls (52.09 ± 9.27 mL min(-1)100g(-1), P<0.001). Voxel-wise ANOCOVA results showed that CBFs were significantly different among three groups in multiple gray matter areas (P<0.05, Bonferroni corrected). Post hoc comparisons showed that CBF of these brain regions was increased in MHE patients compared with controls and non-HE patients (P<0.05, Bonferroni corrected). CBF of the right putamen was of the highest sensitivity (93.8%) and moderate specificity (75.0%) for characterization of MHE when using the cutoff value of 50.57 mL min(-1)100g(-1). CBFs in the bilateral median cingulate gyri, left supramarginal gyrus, right angular gyrus, right heschl gyrus and right superior temporal gyrus have both sensitivity and specificity of approximately 80% for the diagnosis of MHE.

CONCLUSION

Higher CBF was found in many brain regions in cirrhotic patients than controls and gradually increased with the progress of disease. CBF measured with ASL MRI can be a useful marker for differentiating MHE from non-HE patients.

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  • Authors+Show Affiliations

    ,

    Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, 210002, China; College of Civil Aviation, Nanjing University of Aeronautics and Astronautics, Nanjing, Jiangsu, 210016, China.

    , , , , ,

    Source

    European journal of radiology 82:11 2013 Nov pg 1981-8

    MeSH

    Biomarkers
    Blood Flow Velocity
    Cerebral Arteries
    Cerebrovascular Circulation
    Female
    Hepatic Encephalopathy
    Humans
    Liver Cirrhosis
    Magnetic Resonance Angiography
    Male
    Middle Aged
    Reproducibility of Results
    Sensitivity and Specificity
    Spin Labels

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    23849331

    Citation

    Zheng, Gang, et al. "Cerebral Blood Flow Measured By Arterial-spin Labeling MRI: a Useful Biomarker for Characterization of Minimal Hepatic Encephalopathy in Patients With Cirrhosis." European Journal of Radiology, vol. 82, no. 11, 2013, pp. 1981-8.
    Zheng G, Zhang LJ, Zhong J, et al. Cerebral blood flow measured by arterial-spin labeling MRI: a useful biomarker for characterization of minimal hepatic encephalopathy in patients with cirrhosis. Eur J Radiol. 2013;82(11):1981-8.
    Zheng, G., Zhang, L. J., Zhong, J., Wang, Z., Qi, R., Shi, D., & Lu, G. M. (2013). Cerebral blood flow measured by arterial-spin labeling MRI: a useful biomarker for characterization of minimal hepatic encephalopathy in patients with cirrhosis. European Journal of Radiology, 82(11), pp. 1981-8. doi:10.1016/j.ejrad.2013.06.002.
    Zheng G, et al. Cerebral Blood Flow Measured By Arterial-spin Labeling MRI: a Useful Biomarker for Characterization of Minimal Hepatic Encephalopathy in Patients With Cirrhosis. Eur J Radiol. 2013;82(11):1981-8. PubMed PMID: 23849331.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Cerebral blood flow measured by arterial-spin labeling MRI: a useful biomarker for characterization of minimal hepatic encephalopathy in patients with cirrhosis. AU - Zheng,Gang, AU - Zhang,Long Jiang, AU - Zhong,Jianhui, AU - Wang,Ze, AU - Qi,Rongfeng, AU - Shi,Donghong, AU - Lu,Guang Ming, Y1 - 2013/07/09/ PY - 2013/01/09/received PY - 2013/05/30/revised PY - 2013/06/03/accepted PY - 2013/7/16/entrez PY - 2013/7/16/pubmed PY - 2014/6/4/medline KW - ASL KW - Arterial-spin labeling KW - CBF KW - Cerebral blood flow KW - Cirrhosis KW - DST KW - HE KW - Hepatic encephalopathy KW - MCC KW - MHE KW - NCT-A KW - OHE KW - PET KW - ROC KW - SPECT KW - TIPS KW - arterial spin labeling KW - cerebral blood flow KW - digit symbol test KW - hepatic encephalopathy KW - median cingulate cortex KW - minimal hepatic encephalopathy KW - non hepatic encephalopathy KW - non-HE KW - number-connection test type A KW - overt hepatic encephalopathy KW - positron emission tomography KW - receiver operator characteristic KW - single photon emission computed tomography KW - transjugular intrahepatic portosystemic shunt. SP - 1981 EP - 8 JF - European journal of radiology JO - Eur J Radiol VL - 82 IS - 11 N2 - PURPOSE: To investigate the role of arterial-spin labeling (ASL) MRI to non-invasively characterize the patterns of cerebral blood flow (CBF) changes in cirrhotic patients and to assess the potential of ASL MRI to characterize minimal hepatic encephalopathy (MHE). MATERIALS AND METHODS: This study was approved by the local ethics committee, and written informed consent was obtained from all participants. Thirty six cirrhosis patients without overt hepatic encephalopathy (16 MHE patients and 20 non hepatic encephalopathy (non-HE) patients) and 25 controls underwent ASL MRI, and CBF was measured for each subject. One-way ANOCOVA test with age and gender as covariences was used to compare CBF difference among three groups, and post hoc analysis was performed between each two groups. Region-based correlation analysis was applied between Child-Pugh score, venous blood ammonia level, neuropsychological tests and CBF values in cirrhosis patients. Receiver operator characteristic (ROC) analysis was used for assessing CBF measurements in ASL MRI to differentiate MHE from non-HE patients. RESULTS: The gray matter CBF of MHE patients (71.09 ± 11.88 mL min(-1)100g(-1)) was significantly higher than that of non-HE patients (55.28 ± 12.30 mL min(-1)100g(-1), P<0.01) and controls (52.09 ± 9.27 mL min(-1)100g(-1), P<0.001). Voxel-wise ANOCOVA results showed that CBFs were significantly different among three groups in multiple gray matter areas (P<0.05, Bonferroni corrected). Post hoc comparisons showed that CBF of these brain regions was increased in MHE patients compared with controls and non-HE patients (P<0.05, Bonferroni corrected). CBF of the right putamen was of the highest sensitivity (93.8%) and moderate specificity (75.0%) for characterization of MHE when using the cutoff value of 50.57 mL min(-1)100g(-1). CBFs in the bilateral median cingulate gyri, left supramarginal gyrus, right angular gyrus, right heschl gyrus and right superior temporal gyrus have both sensitivity and specificity of approximately 80% for the diagnosis of MHE. CONCLUSION: Higher CBF was found in many brain regions in cirrhotic patients than controls and gradually increased with the progress of disease. CBF measured with ASL MRI can be a useful marker for differentiating MHE from non-HE patients. SN - 1872-7727 UR - https://www.unboundmedicine.com/medline/citation/23849331/Cerebral_blood_flow_measured_by_arterial_spin_labeling_MRI:_a_useful_biomarker_for_characterization_of_minimal_hepatic_encephalopathy_in_patients_with_cirrhosis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0720-048X(13)00295-7 DB - PRIME DP - Unbound Medicine ER -