Cerebral magnetic resonance imaging reveals marked abnormalities of brain tissue density in patients with cirrhosis without overt hepatic encephalopathy

Identification of Minimal Hepatic Encephalopathy in Patients with Cirrhosis Based on White Matter Imaging and Bayesian Data Mining

“…Brain edema has been reported to be fatal, especially in highgrade HE, due to increased intracranial pressure. 37,38 Moreover, our findings regarding the predictive values of MD and FA on survival agree with the consensus that brain edema [9][10][11] and structural impairment 12,13 progress with advanced disease. One strength of this study is the application of an advanced machine-learning method, GAMMA, to the detection of MHErelated biomarkers.…”

“…The thresholds resulting in best classification result (eg, a threshold of 0.25 SD above the mean MD value or a threshold of 0.75 SD below mean FA value) were chosen and included in the following validation analyses. [7][8][9][10][11] and impaired cerebral structures [12][13][14] have been demonstrated to play an important role in the MHE mechanisms. WM edema, which could be extracellular and/or cytotoxic in origin, [8][9][10] is considered closely associated with a metabolic disorder of ammonia in the brain tissue of patients with MHE.…”

“…Abnormalities in brain white matter, such as low-grade edema [7][8][9][10][11] and structural impairments, [12][13][14] have been well-revealed in MHE by MR imaging. These WM abnormalities are believed to be responsible for poor neurologic performances 12,15,16 and brain dysfunctions 17,18 in MHE and to be associated with HE development, 9,11,16 suggesting that WM imaging may be useful in characterizing potential MHE biomarkers.…”

Multimodality MR Imaging Findings of Low-Grade Brain Edema in Hepatic Encephalopathy

“…31 However, this finding appears to be contradictory to the evidence of brain atrophy from voxel-based morphometry. 33 It is possible that mild-to-moderate loss of myelin and axons is not always found in chronic HE. that proinflammatory cytokines showed positive correlation with spheric anisotropy and negative correlation with mean diffusivity in various brain regions, including the spectroscopy voxel in patients with acute liver failure.…”

Brain Imaging and Hepatic Encephalopathy

“…Further evidence of the contribution of atrophy in patients with hepatic encephalopathy has recently emerged with the identification areas of atrophy throughout the cortex and white matter quantitated by VBM and correlating with the severity of encephalopathy (60). A lack of corroborative MR spectroscopy or more advanced water localisation sequences could not add further mechanistic data to this interesting observation, which requires validation from other groups.…”