Magnetic Resonance Spectroscopy for Evaluating Portal-Systemic Encephalopathy in Patients with Chronic Hepatic Schistosomiasis Japonicum

Abstract

Portal-systemic encephalopathy (PSE) is classified as type B hepatic encephalopathy. Portal-systemic shunting rather than liver dysfunction is the main cause of PSE in chronic hepatic schistosomiasis japonicum (HSJ) patients. Owing to lack of detectable evidence of intrinsic liver disease, chronic HSJ patients with PSE are frequently clinically undetected or misdiagnosed, especially chronic HSJ patients with covert PSE (subclinical encephalopathy). In this study, we investigated whether magnetic resonance spectroscopy (MRS) could be a useful tool for diagnosing PSE in chronic HSJ patients. Magnetic resonance (MR) T1-weighted imaging, diffusion-weighted imaging, and MRS were performed in 41 chronic HSJ patients with suspected PSE and in 21 age-matched controls. The T1 signal intensity index (T1SI) and apparent diffusion coefficient (ADC) value were obtained in the Globus pallidus. Liver function was also investigated via serum ammonia and liver function tests. Higher T1SI and ADC values, increased lactate and glutamine levels, and decreased myo-inositol were found in the bilateral Globus pallidus in chronic HSJ patients with PSE. No significantly abnormal serum ammonia or liver function tests were observed in chronic HSJ patients with PSE. On the basis of these findings, we propose a diagnostic procedure for PSE in chronic HSJ patients. This study reveals that MRS can be useful for diagnosing PSE in chronic HSJ patients.

UHPLC-MS-Based Metabolomics Analysis Reveals the Process of Schistosomiasis in Mice

“…Lactic acid, as a product of glycolysis, was found to be significantly higher in the serum of infected mice than in control mice, indicating that the glycolytic pathway of the infected mice was activated. This finding is also consistent with previous research conclusion that lactate was increased in schistosomiasis patients ( Li et al, 2016 ). However, there is a difference in the conclusion that the host’s TCA cycle is inhibited after schistosomiasis infection ( Tanabe et al, 1989 ; Ahmed and Gad, 1995 ).…”

Prediction of minimal hepatic encephalopathy by using an radiomics nomogram in chronic hepatic schistosomiasis patients

“…Neurological symptoms of HE include personality change, attention deficits, sleep rhythms alteration and mild cognitive impairment (minimal hepatic encephalopathy, MHE) progressing to stupor and coma (overt hepatic encephalopathy, OHE) [2][3][4]. MHE is usually neglected clinically in CHS patients because of lacking biochemical evidence of intrinsic liver disease [1,5]. As MHE progresses, OHE occurs.…”

“…The exact pathophysiological mechanism of HE is still unknown. Evidences suggest that cytotoxic brain edema (astrocyte swelling) and substantia nigra-striatum system dysfunction are implicated in the pathogenesis of HE [ 1 , 3 , 5 ]. As a non-invasive tool, magnetic resonance imaging (MRI) has widely used to investigate the localization and pathophysiological mechanisms of brain functions, such as cognition and sensory perception [ 1 , 5 , 7 ].…”

“…Evidences suggest that cytotoxic brain edema (astrocyte swelling) and substantia nigra-striatum system dysfunction are implicated in the pathogenesis of HE [ 1 , 3 , 5 ]. As a non-invasive tool, magnetic resonance imaging (MRI) has widely used to investigate the localization and pathophysiological mechanisms of brain functions, such as cognition and sensory perception [ 1 , 5 , 7 ]. An elevated ADC values on diffusion weighted imaging (DWI), increased mean diffusivity on diffusion tensor imaging (DTI), increased cerebral blood perfusion on arterial spin labeling (ASL) and abnormal metabolism on MR spectroscopy in substantia nigra-striatum system of HE patients were reported [ 5 , 6 , 8 , 9 ].…”

“…As a non-invasive tool, magnetic resonance imaging (MRI) has widely used to investigate the localization and pathophysiological mechanisms of brain functions, such as cognition and sensory perception [ 1 , 5 , 7 ]. An elevated ADC values on diffusion weighted imaging (DWI), increased mean diffusivity on diffusion tensor imaging (DTI), increased cerebral blood perfusion on arterial spin labeling (ASL) and abnormal metabolism on MR spectroscopy in substantia nigra-striatum system of HE patients were reported [ 5 , 6 , 8 , 9 ]. DWI, reflecting the diffusion of water molecules, has been proved to be useful for diagnosing HE in cirrhosis [ 6 ].…”