Brain Perfusion Single Photon Emission Computed Tomography Abnormalities in Patients with Minimal Hepatic Encephalopathy

Sunil, H; Mittal, Bhagwant Rai; Kurmi, Roshan; Chawla, Yogesh; Dhiman, Radha K.

doi:10.1016/s0973-6883(12)60099-1

Cited by 11 publications

(8 citation statements)

References 31 publications

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“…The data were acquired in a 128 × 128 matrix over 360°rotation performing 65 frames of 25 s duration. Filtered backprojection reconstruction (Butterworth filter 5, critical frequency of 0.5 cycles/min) was applied as recommended (Morano and Seibyl 2003;Sunil et al 2012). A specialist who was unaware of the clinical data used the software Statistical Parametric Mapping (SPM) (Wellcome Trust Centre for Neuroimaging, London) version 8 for the analysis.…”

Section: Study Protocolmentioning

confidence: 99%

Lower values of handgrip strength and adductor pollicis muscle thickness are associated with hepatic encephalopathy manifestations in cirrhotic patients

et al. 2016

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Hepatic encephalopathy (HE) is a late complication of liver cirrhosis and is clearly associated with poor outcomes. Chronic liver insufficiency leads to progressive muscle wasting, impairing ammonia metabolism and thus increasing the risk for HE. Given the association between lean mass and adductor pollicis muscle thickness (APMT), it has been used to predict outcome and complications in many conditions, but not yet in cirrhotic patients. Therefore, this article aimed to study the association between HE manifestations and measures related to muscle mass and strength. This cross-sectional study included 54 cirrhotic outpatients with HE varying from subclinical to grade II according to the West-Haven criteria, who were submitted to neuropsychometric tests, electroencephalogram, brain Single Photon Emission Computed Tomography (SPECT), anthropometric measurements, handgrip strength (HGS) and dual energy X-ray absorptiometry exam (DXA). Multiple logistic regression analysis was performed to investigate the association between body composition measures and HE grade. Analysis of the area under the receiver operator characteristic (AUROC) curve revealed the values related to neurological manifestations (HE grades I and II). Reductions in APMT and HGS were associated with higher HE grades, suggesting a big impact caused by the loss of muscle mass and function on HE severity. The link between HE manifestations and anthropometric measures, namely APMT and HGS, point to a significant relation concerning skeletal muscles and the neurological impairment in this population.

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Section: Study Protocolmentioning

confidence: 99%

Lower values of handgrip strength and adductor pollicis muscle thickness are associated with hepatic encephalopathy manifestations in cirrhotic patients

et al. 2016

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“…The acquisition was made in a 128 × 128 matrix with voxel sizes of 2.26 × 2.26 × 2.26 mm 3 , thus resulting in a resolution of 0.44 pixels/mm over 360° rotation performing 65 frames of 25 s each. A fifth-order Butterworth high-pass filter with cutoff frequency of 0.5 cycles/min was applied to perform the filtered backprojection reconstruction ( Morano and Seibyl, 2003 ; Sunil et al, 2012 ). A specialist who was unaware of the supplement given performed the SPECT analysis (details included as Supplementary material).…”

Section: Methodsmentioning

confidence: 99%

“…The present study hypothesizes that the long-term effects of isoleucine leads to a higher increase in cerebral perfusion than that obtained by leucine, thus promoting different degrees of recovery from HE according to the amino acid received by the subjects. Hence, the study was focused on brain areas that are known for being more affected by hypoperfusion, such as the basal ganglia ( Bizzi et al, 1996 ; Kumar et al, 1991 ; Sims and Pulsinelli, 1987 ), as well as regions where altered perfusion was already reported in HE and/or acquired hepatocerebral degeneration, such as the hippocampus, prefrontal cortex, medial temporal cortex, anterior cingulate cortex and parietooccipital regions ( Lockwood et al, 1993 ; O'Carroll et al, 1991 ; Sunil et al, 2012 ; Ueki et al, 2002 ; Zafiris et al, 2004 ). Perfusion alterations in some of these regions were already associated with HE symptoms in prior studies, while some areas were reported as having dissimilar blood flow responses after BCAA administration ( Catafau et al, 2000 ; Iwasa et al, 2003 ; Lockwood et al, 1993 ; O'Carroll et al, 1991 ; Ueki et al, 2002 ).…”

Section: Introductionmentioning

confidence: 99%

Which of the branched-chain amino acids increases cerebral blood flow in hepatic encephalopathy? A double-blind randomized trial

Romeiro

Ietsugu

Franzoni

et al. 2018

NeuroImage: Clinical

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Branched-chain amino acids increase the brain perfusion of patients with hepatic encephalopathy (HE), but the amino acid and the mechanisms involved are still unknown. This study compared brain perfusion and clinical improvement during leucine or isoleucine supplementation. After randomization, 27 subjects with cirrhosis and HE received leucine or isoleucine supplements for one year. Brain single Photon Emission Computed Tomography (SPECT) and dynamic brain scintigraphy (DBS) were performed pretreatment and at 1, 8 and 12 months of supplementation. Brain perfusion was increased only in the isoleucine group at 8 months of treatment by both SPECT and DBS (p < 0.001 and p = 0.05, respectively) and by SPECT at the 12th month (p < 0.05). This was associated with hepatic encephalopathy improvement at 8 and 12 months (p = 0.008 and 0.004, respectively), which was not observed in the leucine group (p = 0.313 and 0.055, respectively). Isoleucine supplementation achieved a better impact on brain perfusion restoration in HE.

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“…Although insufficient clearance of toxins from blood, hyperammonemia, increased oxidative stress and enhanced inflammatory pathways are pivotal in the pathophysiology of HE, abnormalities in cerebral blood flow are also implicated in the development of this syndrome (Shawcross et al, 2004;Shawcross and Jalan, 2005). Both increases and decreases in cerebral vasculature resistance have been reported in HE, depending on the seriousness of the pathology, and can lead to either a decrease or an increase in cerebral blood flow, respectively (Guevara et al, 1998;Hollingsworth et al, 2010;Sunil et al, 2012;Dam et al, 2013;Zheng et al, 2013). In fact, an increased cerebral blood flow has been reported to correlate with raised intracranial pressure in patients with ACLF (Kerbert et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

Hepatic Encephalopathy-Associated Cerebral Vasculopathy in Acute-on-Chronic Liver Failure: Alterations on Endothelial Factor Release and Influence on Cerebrovascular Function

et al. 2020

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The acute-on-chronic liver failure (ACLF) is a syndrome characterized by liver decompensation, hepatic encephalopathy (HE) and high mortality. We aimed to determine the mechanisms implicated in the development of HE-associated cerebral vasculopathy in a microsurgical liver cholestasis (MHC) model of ACLF. Microsurgical liver cholestasis was induced by ligating and extracting the common bile duct and four bile ducts. Sham-operated and MHC rats were maintained for eight postoperative weeks Bradykinin-induced vasodilation was greater in middle cerebral arteries from MHC rats. Both Nω-Nitro-L-arginine methyl ester and indomethacin diminished bradykinin-induced vasodilation largely in arteries from MHC rats. Nitrite and prostaglandin (PG) F1α releases were increased, whereas thromboxane (TX) B2 was not modified in arteries from MHC. Expressions of endothelial nitric oxide synthase (eNOS), inducible NOS, and cyclooxygenase (COX) 2 were augmented, and neuronal NOS (nNOS), COX-1, PGI2 synthase, and TXA2S were unmodified. Phosphorylation was augmented for eNOS and unmodified for nNOS. Altogether, these endothelial alterations might collaborate to increase brain blood flow in HE.

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Brain Perfusion Single Photon Emission Computed Tomography Abnormalities in Patients with Minimal Hepatic Encephalopathy

Cited by 11 publications

References 31 publications

Lower values of handgrip strength and adductor pollicis muscle thickness are associated with hepatic encephalopathy manifestations in cirrhotic patients

Lower values of handgrip strength and adductor pollicis muscle thickness are associated with hepatic encephalopathy manifestations in cirrhotic patients

Which of the branched-chain amino acids increases cerebral blood flow in hepatic encephalopathy? A double-blind randomized trial

Hepatic Encephalopathy-Associated Cerebral Vasculopathy in Acute-on-Chronic Liver Failure: Alterations on Endothelial Factor Release and Influence on Cerebrovascular Function

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