Current Stance of Magnetic Resonance Imaging in the Diagnosis and Monitoring of Hepatic Encephalopathy

Abstract

Objectives: Hepatic encephalopathy is a complex of neuropsychiatric manifestations in patients with acute or chronic liver insufficiency and/or porto-systemic shunts.

Material and methods: The diagnostic can be sustained by various elements, clinical and paraclinical. Selected patients with hepatic encephalopathy have been investigated by Magnetic Resonance, in parallel with specific biochemical analysis.

Outcomes: This paper emphasizes the importance of Magnetic Resonance Imaging in an accurate diagnosis and patient monitoring after treatment.

Conclusions: Magnetic Resonance Spectroscopy has a substantial role, showing even minute metabolite ratio changes, with a potential in investigating minimal hepatic encephalopathy.

Figure 1

Figure 1. T1 Spin Echo weighted images, located at the level of the basal ganglia. Note the hyperintensity of globus pallidus bilaterally (arrow) in the patient with HE (left) compared to a normal patient (right). This sequence is commonly performed in an oblique axial plane (bicommissural).

Figure 2

Figure 2. Hyperintensities in the corticospinal tracts bilaterally (arrows), more prominent on the left side, in the same patient. T2 TSE axial plane (a), DWI (b) and FLAIR coronal plane (c) sequences.

Figure 3

Figure 3. Single voxel MR spectroscopy investigation in a patient with HE (left) compared to a normal patient (right). Typical and highly specific changes, represented by an increased Glutamate-Glutamine- Gamaaminobutyric acid (Glx) peak accompanied by a decrease of the myoinositol (mI) and Creatine (Cr) peaks. Voxel location in each case is referenced in corresponding thumbnails.