Identification of minimal hepatic encephalopathy based on dynamic functional connectivity

Cheng, Ying-Sheng; Zhang, Gaoyan; Zhang, Xiaodong; Li, Yuexuan; Li, Jingyuan; Zhou, Jia-Min; Huang, Libing; Xie, Shuangshuang; Shen, Wen

doi:10.1007/s11682-021-00468-x

Cited by 13 publications

(11 citation statements)

References 50 publications

(43 reference statements)

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“…HE is also associated with regional differential alterations. The cerebellum is one of the regions that of high susceptibility in HE, which has been proved in patient imaging examinations and various animal experiments ( 50 – 52 ). Apoptosis is one of the major ways leading to neurologic damage ( 53 ).…”

Section: Discussionmentioning

confidence: 96%

Pathological Significance and Prognostic Roles of Indirect Bilirubin/Albumin Ratio in Hepatic Encephalopathy

Liu

Chen

et al. 2021

Front. Med.

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Background and Aim: Hepatic encephalopathy (HE) is a neurological disease caused by severe liver disease. Early identification of the risk factor is beneficial to the prevention and treatment of HE. Free bilirubin has always been considered to be the culprit of neonatal kernicterus, but there is no research to explore its role in HE. In this study, we aim to study the clinical significance of the indirect bilirubin-albumin ratio in HE.Methods: A retrospective case-control study of 204 patients with liver failure was conducted. Human serum albumin (HSA) or heme oxygenase-1 (HO-1) inhibitor SnPP (Tin protoporphyrin IX dichloride) was injected intraperitoneally into Ugt1−/− mice to establish a treatment model for endogenous hyperbilirubinemia.Results: IBil/albumin ratio (OR = 1.626, 95% CI1.323–2.000, P < 0.001), white blood cell (WBC) (OR = 1.128, 95% CI 1.009–1.262, P = 0.035), ammonia (OR = 1.010, 95% CI 1.001–1.019, P = 0.027), platelet (OR=1.008, 95% CI 1.001–1.016, P = 0.022), Hb (OR = 0.977, 95% CI 0.961–0.994, P = 0.007), and PTA (OR = 0.960, 95% CI 0.933–0.987, P = 0.005) were independent factors of HE. Patients with a history of liver cirrhosis and severe HE (OR = 12.323, 95% CI 3.278–47.076, P < 0.001) were more likely to die during hospitalization. HSA or SnPP treatment improved cerebellum development and reduced apoptosis of cerebellum cells.Conclusion: The IBil/albumin ratio constitutes the most powerful risk factor in the occurrence of HE, and reducing free bilirubin may be a new strategy for HE treatment.

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Section: Discussionmentioning

confidence: 96%

Pathological Significance and Prognostic Roles of Indirect Bilirubin/Albumin Ratio in Hepatic Encephalopathy

Liu

Chen

et al. 2021

Front. Med.

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“…According to previous studies, the diagnosis of mild hepatic encephalopathy is based on neuropsychological assessments from the PHES, which include the type A number connection test (NCT-A) and digit-symbol test (DST) ( Cheng et al, 2021 ). If both of above tests were positive, the patient was diagnosed with mild hepatic encephalopathy, and if one test was positive, the patient was diagnosed with simple cirrhosis.…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, new insights may be gained by using dALFF to explore brain function in MHE. Specifically, we compared the discriminative power of dALFF, sALFF and both two features by using SVM, a typical machine learning classification tool ( Chen et al, 2016a ; Chen et al, 2020b ; Cheng et al, 2021 ). We also used a general linear model in MHE to predict the Child–Pugh score, a scale commonly used clinically to measure the degree of liver damage in cirrhosis patients.…”

Section: Introductionmentioning

confidence: 99%

Changes in dynamic and static brain fluctuation distinguish minimal hepatic encephalopathy and cirrhosis patients and predict the severity of liver damage

Jiang

Liu

et al. 2023

Front. Neurosci.

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PurposeMinimal hepatic encephalopathy (MHE) is characterized by mild neuropsychological and neurophysiological alterations that are not detectable by routine clinical examination. Abnormal brain activity (in terms of the amplitude of low-frequency fluctuation (ALFF) has been observed in MHE patients. However, little is known concerning temporal dynamics of intrinsic brain activity. The present study aimed to investigate the abnormal dynamics of brain activity (dynamic ALFF; dALFF) and static measures [static ALFF; (sALFF)] in MHE patients and to strive for a reliable imaging neuromarkers for distinguishing MHE patients from cirrhosis patients. In addition, the present study also investigated whether intrinsic brain activity predicted the severity of liver damage.MethodsThirty-four cirrhosis patients with MHE, 28 cirrhosis patients without MHE, and 33 age-, sex-, and education-matched healthy controls (HCs) underwent resting-state magnetic resonance imaging (rs-fMRI). dALFF was estimated by combining the ALFF method with the sliding-window method, in which temporal variability was quantized over the whole-scan timepoints and then compared among the three groups. Additionally, dALFF, sALFF and both two features were utilized as classification features in a support vector machine (SVM) to distinguish MHE patients from cirrhosis patients. The severity of liver damage was reflected by the Child–Pugh score. dALFF, sALFF and both two features were used to predict Child–Pugh scores in MHE patients using a general linear model.ResultsCompared with HCs, MHE patients showed significantly increased dALFF in the left inferior occipital gyrus, right middle occipital gyrus, and right insula; increased dALFF was also observed in the right posterior lobe of the cerebellum (CPL) and right thalamus. Compared with HCs, noMHE patients exhibited decreased dALFF in the right precuneus. In contrast, compared with noMHE patients, MHE patients showed increased dALFF in the right precuneus, right superior frontal gyrus, and right superior occipital gyrus. Furthermore, the increased dALFF values in the left precuneus were positively associated with poor digit-symbol test (DST) scores (r = 0.356, p = 0.038); however, dALFF in the right inferior temporal gyrus (ITG) was negatively associated with the number connection test–A (NCT-A) scores (r = -0.784, p = 0.000). A significant positive correlation was found between dALFF in the left inferior occipital gyrus (IOG) and high blood ammonia levels (r = 0.424, p = 0.012). Notably, dALFF values yielded a higher classification accuracy than sALFF values in distinguishing MHE patients from cirrhosis patients. Importantly, the dALFF values predicted the Child–Pugh score (r = 0.140, p = 0.030), whereas sALFF values did not in the current dataset. Combining two features had high accuracy in classification in distinguishing MHE patients from cirrhotic patients and yielded prediction in the severity of liver damage.ConclusionThese findings suggest that combining dALFF and sALFF features is a useful neuromarkers for distinguishing MHE patients from cirrhosis patients and highlights the important role of dALFF feature in predicting the severity of liver damage in MHE.

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“…The authors acquired functional magnetic resonance images of 32 patients without hepatic encephalopathy and 30 patients with MHE diagnosed by neuropsychiatric testing (number connection test A and digit symbol test, both adjusted for age and education). After feature selection, the authors used support-vector machines to find that the overall strength of the nodal degree fluctuation with time had the best discrimination accuracy on the leave-one-out cross-validation (72.5%), which was 10.5% higher compared to static features [54].…”

Section: Existing Application Of Artificial Intelligence To Mhe Diagnosismentioning

confidence: 99%

Artificial Intelligence and Its Application to Minimal Hepatic Encephalopathy Diagnosis

Gazda

Drotár

Dražilová

et al. 2021

JPM

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Hepatic encephalopathy (HE) is a brain dysfunction caused by liver insufficiency and/or portosystemic shunting. HE manifests as a spectrum of neurological or psychiatric abnormalities. Diagnosis of overt HE (OHE) is based on the typical clinical manifestation, but covert HE (CHE) has only very subtle clinical signs and minimal HE (MHE) is detected only by specialized time-consuming psychometric tests, for which there is still no universally accepted gold standard. Significant progress has been made in artificial intelligence and its application to medicine. In this review, we introduce how artificial intelligence has been used to diagnose minimal hepatic encephalopathy thus far, and we discuss its further potential in analyzing speech and handwriting data, which are probably the most accessible data for evaluating the cognitive state of the patient.

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Identification of minimal hepatic encephalopathy based on dynamic functional connectivity

Cited by 13 publications

References 50 publications

Pathological Significance and Prognostic Roles of Indirect Bilirubin/Albumin Ratio in Hepatic Encephalopathy

Pathological Significance and Prognostic Roles of Indirect Bilirubin/Albumin Ratio in Hepatic Encephalopathy

Changes in dynamic and static brain fluctuation distinguish minimal hepatic encephalopathy and cirrhosis patients and predict the severity of liver damage

Artificial Intelligence and Its Application to Minimal Hepatic Encephalopathy Diagnosis

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