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Evaluation of cognitivity, proinflammatory cytokines, and brain magnetic resonance imaging in minimal hepatic encephalopathy induced by cirrhosis and extrahepatic portal vein obstruction.
J Gastroenterol Hepatol. 2016 Dec; 31(12):1986-1994.JG

Abstract

BACKGROUND AND AIMS

Minimal hepatic encephalopathy (MHE) is the mildest form of hepatic encephalopathy (HE) and is characterized by deficits in neurocognitive performance without any clinical symptoms of HE. In the current study, we aim to evaluate and compare the neurocognitive, biochemical, and brain magnetic resonance (MR) imaging changes between patients with cirrhotic MHE and extrahepatic portal vein obstruction (EHPVO) MHE.

METHODS

Thirty-three cirrhotic and 14 EHPVO patients were diagnosed with MHE and were included in the analysis along with 24 normal healthy volunteers. All subjects underwent MR imaging including diffusion tensor imaging and proton MR spectroscopy (1 H-MRS) followed by cognitive assessments, critical flicker frequency (CFF) measurements, quantification of blood ammonia, and serum proinflammatory cytokine levels.

RESULTS

We observed abnormal neurocognitive functions and CFF measurements in both cirrhotic MHE and EHPVO MHE patients as compared with controls. Significantly increased blood ammonia, serum proinflammatory cytokines (IL-6, TNF-α) level, mean diffusivity in multiple brain sites, 1 H-MRS derived glutamate/glutamine (Glx)/creatine (Cr), and significantly decreased 1 H-MRS derived myo-inositol/Cr were observed in both cirrhotic MHE and EHPVO MHE compared with those of controls. Choline/Cr level was significantly decreased in cirrhotic MHE as compared with controls and EHPVO MHE.

CONCLUSIONS

Cirrhotic MHE showed more severe changes on mean diffusivity in multiple brain sites and inflammation as compared with EHPVO MHE. This study confirms that there are significant difference in neurocognitive, biochemical, and MR profile between cirrhotic MHE and EHPVO MHE, which may help to understand the pathophysiologies of these two types of MHE and may contribute to improve their clinical managements.

Authors+Show Affiliations

Research Branch, Sidra Medical and Research Center, Doha, Qatar.Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.Department of Radiological Sciences, David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California, USA.Research Branch, Sidra Medical and Research Center, Doha, Qatar.Research Branch, Sidra Medical and Research Center, Doha, Qatar.Research Branch, Sidra Medical and Research Center, Doha, Qatar.Department of Radiology, Fortis Memorial Research Institute, Gurgaon, Haryana, India.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

27119420

Citation

Yadav, Santosh K., et al. "Evaluation of Cognitivity, Proinflammatory Cytokines, and Brain Magnetic Resonance Imaging in Minimal Hepatic Encephalopathy Induced By Cirrhosis and Extrahepatic Portal Vein Obstruction." Journal of Gastroenterology and Hepatology, vol. 31, no. 12, 2016, pp. 1986-1994.
Yadav SK, Goel A, Saraswat VA, et al. Evaluation of cognitivity, proinflammatory cytokines, and brain magnetic resonance imaging in minimal hepatic encephalopathy induced by cirrhosis and extrahepatic portal vein obstruction. J Gastroenterol Hepatol. 2016;31(12):1986-1994.
Yadav, S. K., Goel, A., Saraswat, V. A., Thomas, M. A., Wang, E., Marincola, F. M., Haris, M., & Gupta, R. K. (2016). Evaluation of cognitivity, proinflammatory cytokines, and brain magnetic resonance imaging in minimal hepatic encephalopathy induced by cirrhosis and extrahepatic portal vein obstruction. Journal of Gastroenterology and Hepatology, 31(12), 1986-1994. https://doi.org/10.1111/jgh.13427
Yadav SK, et al. Evaluation of Cognitivity, Proinflammatory Cytokines, and Brain Magnetic Resonance Imaging in Minimal Hepatic Encephalopathy Induced By Cirrhosis and Extrahepatic Portal Vein Obstruction. J Gastroenterol Hepatol. 2016;31(12):1986-1994. PubMed PMID: 27119420.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Evaluation of cognitivity, proinflammatory cytokines, and brain magnetic resonance imaging in minimal hepatic encephalopathy induced by cirrhosis and extrahepatic portal vein obstruction. AU - Yadav,Santosh K, AU - Goel,Amit, AU - Saraswat,Vivek A, AU - Thomas,Michael A, AU - Wang,Ena, AU - Marincola,Francesco M, AU - Haris,Mohammad, AU - Gupta,Rakesh K, PY - 2016/04/20/accepted PY - 2016/4/28/pubmed PY - 2017/5/16/medline PY - 2016/4/28/entrez KW - cirrhosis KW - extrahepatic portal vein obstruction KW - magnetic resonance imaging KW - mean diffusivity KW - minimal hepatic encephalopathy SP - 1986 EP - 1994 JF - Journal of gastroenterology and hepatology JO - J Gastroenterol Hepatol VL - 31 IS - 12 N2 - BACKGROUND AND AIMS: Minimal hepatic encephalopathy (MHE) is the mildest form of hepatic encephalopathy (HE) and is characterized by deficits in neurocognitive performance without any clinical symptoms of HE. In the current study, we aim to evaluate and compare the neurocognitive, biochemical, and brain magnetic resonance (MR) imaging changes between patients with cirrhotic MHE and extrahepatic portal vein obstruction (EHPVO) MHE. METHODS: Thirty-three cirrhotic and 14 EHPVO patients were diagnosed with MHE and were included in the analysis along with 24 normal healthy volunteers. All subjects underwent MR imaging including diffusion tensor imaging and proton MR spectroscopy (1 H-MRS) followed by cognitive assessments, critical flicker frequency (CFF) measurements, quantification of blood ammonia, and serum proinflammatory cytokine levels. RESULTS: We observed abnormal neurocognitive functions and CFF measurements in both cirrhotic MHE and EHPVO MHE patients as compared with controls. Significantly increased blood ammonia, serum proinflammatory cytokines (IL-6, TNF-α) level, mean diffusivity in multiple brain sites, 1 H-MRS derived glutamate/glutamine (Glx)/creatine (Cr), and significantly decreased 1 H-MRS derived myo-inositol/Cr were observed in both cirrhotic MHE and EHPVO MHE compared with those of controls. Choline/Cr level was significantly decreased in cirrhotic MHE as compared with controls and EHPVO MHE. CONCLUSIONS: Cirrhotic MHE showed more severe changes on mean diffusivity in multiple brain sites and inflammation as compared with EHPVO MHE. This study confirms that there are significant difference in neurocognitive, biochemical, and MR profile between cirrhotic MHE and EHPVO MHE, which may help to understand the pathophysiologies of these two types of MHE and may contribute to improve their clinical managements. SN - 1440-1746 UR - https://www.unboundmedicine.com/medline/citation/27119420/Evaluation_of_cognitivity_proinflammatory_cytokines_and_brain_magnetic_resonance_imaging_in_minimal_hepatic_encephalopathy_induced_by_cirrhosis_and_extrahepatic_portal_vein_obstruction_ L2 - https://doi.org/10.1111/jgh.13427 DB - PRIME DP - Unbound Medicine ER -