Abnormal baseline brain activity in patients with HBV-related cirrhosis without overt hepatic encephalopathy revealed by resting-state functional MRI

Abstract

Neurocognitive dysfunction of varying degrees is common in patients with hepatitis B virus-related cirrhosis (HBV-RC) without overt hepatic encephalopathy (OHE). However, the neurobiological mechanisms underlying these dysfunctions are not well understood. We sought to identify changes in the neural activity of patients with HBV-RC without OHE in the resting state by using the amplitude of low-frequency fluctuation (ALFF) method and to determine whether these changes were related to impaired cognition. Resting-state functional MRI data from 30 patients with HBV-RC and 30 healthy controls matched for age, sex, and years of education were compared to determine any differences in the ALFF between the two groups. Cognition was measured with the psychometric hepatic encephalopathy score (PHES), and the relationship between these scores and ALFF variation was assessed. Compared with controls, patients showed widespread lower standardized ALFF (mALFF) values in visual association areas (bilateral lingual gyrus, middle occipital gyrus, and left inferior temporal gyrus), motor-related areas (bilateral precentral gyrus, paracentral lobule, and right postcentral gyrus), and the default mode network (bilateral cuneus/precuneus and inferior parietal lobule). Higher mALFF values were found in the bilateral orbital gyrus/rectal gyrus. In patients, mALFF values were significantly positive correlated with the PHES in the right middle occipital gyrus and bilateral precentral gyrus. Our findings of resting-state abnormalities in patients with HBV-RC without OHE suggest that neurocognitive dysfunction in patients with HBV-RC without OHE may be caused by abnormal neural activity in multiple brain regions.

Cortical signature of patients with HBV-related cirrhosis without overt hepatic encephalopathy: a morphometric analysis

“…Using cortical thickness, surface area and lGI, this study aims to perform a comprehensive analysis on the cortical morphometry of a relatively homogeneous sample of patients with HBV-RC without OHE (HBV-RC-NOHE) vs. matched healthy controls. Based on previous studies (Montoliu et al, 2012 ; Lv et al, 2013a , b ), we hypothesized that patients with HBV-RC-NOHE would exhibit cortical thickness reduction in multiple brain regions including the parietal lobe, the temporal lobe and the occipital lobe. In addition, given that many studies have reported intensive white matter abnormalities (Kumar et al, 2008 ; Chen et al, 2012 ; Qi et al, 2013 ) and the hypothesis that cortical gyrification was mainly caused by the tension of the underlying white matter connectivity (Van Essen, 1997 ; Herculano-Houzel et al, 2010 ), cortical gyrification alterations are also expected in patients with HBV-RC-NOHE.…”

“…In contrast, cirrhotic patients without OHE do not present recognizable clinical neuropsychiatric symptoms but associate with a varying degree of cognitive deficits mainly in visual perception, visuo-constructive abilities, fine motor performance, attention and memory (Lv et al, 2013a ), which could be quantitatively measured by the psychometric hepatic encephalopathy score (PHES; Weissenborn, 2008 ). Using resting-state functional magnetic resonance imaging (fMRI) data, several studies have been conducted to explore the neural correlates of the cognitive deficits in cirrhotic patients without OHE (Lv et al, 2013a , b ; Chen et al, 2014 ). Nevertheless, little effort has been made to investigate the cortical integrity in cirrhotic patients without OHE.…”

Machine Learning Classification of Cirrhotic Patients with and without Minimal Hepatic Encephalopathy Based on Regional Homogeneity of Intrinsic Brain Activity

“…Recent resting-state functional magnetic resonance imaging (fMRI) studies also emphasize the importance of aberrant brain intrinsic activity in the pathogenesis of MHE. For example, Chen and colleagues [ 12 , 13 ] report MHE-related changes in brain regional intrinsic neuronal activity by measuring the amplitude of low-frequency fluctuations (ALFF) in fMRI signals. Similarly, regional homogeneity (ReHo), an index reflecting the local synchrony of intrinsic brain activity, is also shown to be altered in MHE patients [ 14 ].…”

Health-related quality of life in patients with chronic hepatitis B during antiviral treatment and off-treatment

“…In addition to HBV effects on liver, patients with CHB may exhibit depression and reduction in their HRQoL. HBV infection could influence the central nervous system and cause cognitive dysfunction in many ways 23,24. However, the mechanism between behavioral disorders that negatively affect HRQoL and HBV chronic infection is still unknown.…”