Decreased white matter lesion volume and improved cognitive function after liver transplantation

Rovira, Àlex; Mínguez, Beatriz; Aymerich, Francesc Xavier; Jacas, Carlos; Huerga, Elena Charro; Córdoba, Juan; Alonso, Juli

doi:10.1002/hep.21911

Cited by 82 publications

(68 citation statements)

References 33 publications

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“…104 Due to their location and small size, WMLs in patients with cirrhosis can be easily ignored or interpreted as normal involutive or chronic ischemic changes. However in patients with cirrhosis, these lesions decreased their volume with the improvement of HE 105 or after liver transplantation, 106 a fact that is closely correlated with the improvement of neuropsychological function (Fig 4). The partial reversibility of these focal WMLs is on the opposite side of what occurs with focal WMLs attributable to cerebrovascular small-vessel disease.…”

Section: Fast Flair Sequencesmentioning

confidence: 77%

MR Imaging Findings in Hepatic Encephalopathy

Rovira¹,

Alonso²,

Córdoba³

2008

AJNR Am J Neuroradiol

306

218

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SUMMARY:The term hepatic encephalopathy (HE) includes a spectrum of neuropsychiatric abnormalities occurring in patients with liver dysfunction. Most cases are associated with cirrhosis and portal hypertension or portal-systemic shunts, but the condition can also be seen in patients with acute liver failure and, rarely, with portal-systemic bypass and no associated intrinsic hepatocellular disease. Although HE is a clinical condition, several neuroimaging techniques, particularly MR imaging, may eventually be useful for the diagnosis because they can identify and measure the consequences of central nervous system (CNS) increase in substances that under normal circumstances, are efficiently metabolized by the liver. Classic MR imaging abnormalities include high signal intensity in the globus pallidum on T1-weighted images, likely a reflection of increased tissue concentrations of manganese, and an elevated glutamine/glutamate peak coupled with decreased myo-inositol and choline signals on proton MR spectroscopy, representing disturbances in cell-volume homeostasis secondary to brain hyperammonemia. Recent data have shown that white matter abnormalities, also related to increased CNS ammonia concentration, can also be detected with several MR imaging techniques such as magnetization transfer ratio measurements, fast fluid-attenuated inversion recovery sequences, and diffusion-weighted images. All these MR imaging abnormalities, which return to normal with restoration of liver function, probably reflect the presence of mild diffuse brain edema, which seems to play an essential role in the pathogenesis of HE. It is likely that MR imaging will be increasingly used to evaluate the mechanisms involved in the pathogenesis of HE and to assess the effects of therapeutic measures focused on correcting brain edema in these patients. Hepatic encephalopathy (HE) reflects a spectrum of neuropsychiatric abnormalities occurring in patients with liver dysfunction. Most cases are associated with cirrhosis and portal hypertension or portal-systemic shunts, but the condition can also be seen in patients with acute liver failure and, rarely, with portal-systemic bypass and no associated intrinsic hepatocellular disease.1,2 The most common clinical pattern in these patients is the development of confusion or coma precipitated by gastrointestinal bleeding, acute superimposed hepatitis, or concomitant infection in a previously asymptomatic patient with cirrhosis. The neurologic manifestations are mainly due to shunt of blood arising from the portal venous bed into the systemic circulation and are reversible once the liver function abnormality or precipitating factor has been corrected. HE can be classified according to the underlying liver disease and the evolution of the neurologic manifestations (Table 1). Clinical FeaturesClinically, HE manifests as a neuropsychiatric syndrome encompassing a wide spectrum of mental and motor disorders.2,3 The changes in mental status range from subtle cognitive dysfunction to severe coma, whereas the...

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Section: Fast Flair Sequencesmentioning

confidence: 77%

MR Imaging Findings in Hepatic Encephalopathy

Rovira¹,

Alonso²,

Córdoba³

2008

AJNR Am J Neuroradiol

306

218

View full text Add to dashboard Cite

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“…To further investigate this observation, the same investigators compared WML volumes in patients with impaired cognition, pre-and post-liver transplantation (32). A significant reduction in WML volume was detected after liver transplantation (Figure 2), as well as a strong negative correlation between fast FLAIR T 2 -weighted lesion load and psychometric score.…”

Section: T 2 -Weighted Mri: Fast Flair Imagingmentioning

confidence: 97%

Brain Imaging and Hepatic Encephalopathy

McPhail

Patel

Taylor‐Robinson

2012

Clinics in Liver Disease

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KEY WORDSHepatic encephalopathy; Brain imaging; Magnetic resonance imaging; Magnetic resonance spectroscopy, Computed tomography, Single photon emission computed tomography; Positron emission tomography. 2 SYNOPSISNovel imaging techniques are allowing hepatologists to investigate the structural and functional neuropathology of hepatic encephalopathy (HE) in greater detail but only limited techniques are applicable to the clinic. Computed tomography and magnetic resonance imaging (MRI) can rule out other diagnoses and in the case of MRI, give certain key diagnostic features in widely available sequences. While increased brain water content is a hallmark of HE, the localisation of low-grade cerebral edema, the extent of regional swelling or atrophy and the different functional characteristics of affected brain regions continue to be debated. More specialised volumetric, diffusion-tensor, magnetization transfer, functional magnetic resonance imaging and magnetic resonance spectroscopy, in conjunction with positron emission tomography continue to enrich the investigative findings in HE. Nevertheless an internationally accepted diagnostic framework that includes an objective imaging test to replace or augment psychometry remains elusive. Quantitative MRI is likely to be the best candidate to become such a test and the utility of MR and nuclear medical techniques to the clinic and results from recent research are described in this article.3

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“…Furthermore, several studies in cirrhotic patients have showed a positive correlation between brain edema (evaluated by different magnetic resonance techniques) and scoring in neuropsychological tests Sugimoto et al, 2008). In addition, following liver transplantation in patients with MHE, a decrease in brain edema was associated with an improvement in cognitive function (Rovira et al, 2007).…”

Section: Role Of Brain Edema In Hementioning

confidence: 99%

Brain edema in acute liver failure and chronic liver disease: Similarities and differences

Bosoi

Rose

2013

Neurochemistry International

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Hepatic encephalopathy (HE) is a complex neuropsychiatric syndrome that typically develops as a result of acute liver failure or chronic liver disease. Brain edema is a common feature associated with HE. In acute liver failure, brain edema contributes to an increase in intracranial pressure, which can fatally lead to brain stem herniation. In chronic liver disease, intracranial hypertension is rarely observed, even though brain edema may be present. This discrepancy in the development of intracranial hypertension in acute liver failure versus chronic liver disease suggests that brain edema plays a different role in relation to the onset of HE. Furthermore, the pathophysiological mechanisms involved in the development of brain edema in acute liver failure and chronic liver disease are dissimilar. This review explores the types of brain edema, the cells, and pathogenic factors involved in its development, while emphasizing the differences in acute liver failure versus chronic liver disease. The implications of brain edema developing as a neuropathological consequence of HE, or as a cause of HE, are also discussed. HighlightsBrain edema is a common feature in ALF and CLD. HE is inconsistently associated with the presence of brain edema. Fibrous and protoplasmic astrocytes are differentially implicated in the pathogenesis of HE. The pathogenesis of HE is multifactorial causing an array of neurological symptoms.

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Decreased white matter lesion volume and improved cognitive function after liver transplantation

Cited by 82 publications

References 33 publications

MR Imaging Findings in Hepatic Encephalopathy

MR Imaging Findings in Hepatic Encephalopathy

Brain Imaging and Hepatic Encephalopathy

Brain edema in acute liver failure and chronic liver disease: Similarities and differences

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