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. 2019 Dec 2:6:350-357.
doi: 10.1016/j.ejro.2019.09.002. eCollection 2019.

Early detection of hepatic encephalopathy after transjugular intrahepatic portsystemic shunt using multiparametric magnetic resonance with spectroscopy

Laura Greco  1 , Fabrizio Chegai  1 , Maria Claudia Pensabene  1 , Laura De Corato  1 , Enrico Pampana  1 , Ilaria Lenci  1 , Francesco Garaci  1 , Roberto Floris  1 , Milena Melis  1
Affiliations

Early detection of hepatic encephalopathy after transjugular intrahepatic portsystemic shunt using multiparametric magnetic resonance with spectroscopy

Laura Greco et al. Eur J Radiol Open. .

Abstract

Background: Hepatic encephalopathy (HE) is a complication of transjugular intrahepatic portosystemic shunt (TIPS).

Aims: Extend the knowledge about the early detection of multiple brain metabolic abnormalities following TIPS; these abnormalities can be detected and managed prior to the clinical manifestation of HE with use of Multiparametric Magnetic Resonance with Spectroscopy.

Methods: 12 cirrhotic Patients underwent TIPS; each Patient underwent a 3 T MRI evaluation before and after TIPS. The spectroscopic images were processed measuring the values of the metabolites N-acetylaspartate (NAA) - Glutamine / Glutamate (Glx) - Colina (Cho) - Myinositol (mI) at the level of the nuclei of the base.

Results: Spectroscopic examination performed before the TIPS procedure showed low values of Cho and Mi, instead following the procedure: an increase in the Glx value, a mean reduction in the values of Cho and mI, a statistically significant reduction in the Cho / Creatine ratio, in the mI / Creatine ratio and an increase of the Glx / Creatine ratio.

Conclusions: Our study demonstrated the efficacy of spectroscopy in Patient subjected to TIPS. MR 3 T with spectroscopy can become a valid tool for monitor the dynamics of changes in brain metabolism after TIPS and to provide an early diagnosis of HE allowing an early treatment.

Keywords: Hepatic encephalopathy (HE); Multiparametric magnetic resonance; Spectroscopy; Transjugular intrahepatic portosystemic shunt (TIPS).

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Conflict of interest statement

We have no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Spectra obtained with Single-voxel Spin Echo (PRESS) in left globus pallidus in 68 years old woman. Can be osserved the 15 × 15 × 15 mm voxel in axial projection (a), sagittal (b) and coronal (c). Spectra obtained with tow different time of echo (TE), respectively 144 msec (d) e 35 msec (e).
Fig. 2
Fig. 2
56 y.o. man before (A) and after (B) TIPS. Spectroscopy shows decreased level of myoinositol (mI) and choline(Cho) whereas there is an higher level of glutamate-glutamine (Glx).
Fig. 3
Fig. 3
Comparison between mean changing of GLX/Cr value pre and post TIPS, also considering the onset of HE. Patients in whom HE arose are the one with colored rectangle and circle.
Graph 1
Graph 1
Variations of Glx/Cr, of Cho/Cr and of mI/Cr value pre and post TIPS analysed with ROC curve, with related sensibility and specificity rate.
Fig. 4
Fig. 4
Comparison between mean changing of Cho/Cr value pre and post TIPS, also considering the onset of HE. Patients in whom HE arose are the one with colored rectangle and circle.
Fig. 5
Fig. 5
Comparison between mean changing of mI/Cr value pre and post TIPS, also considering the onset of HE. Patients in whom HE arose are the one with colored rectangle and circle.
Graph 2
Graph 2
Variations of FA value in different analyzed brain areas, before and after TIPS (P-value < 0.01).
Fig. 6
Fig. 6
61 y.o. Man, bilateral hyperintensity can be seen in both globus pallidus, T-1 weighted -axial (A) and coronal (B).
See this image and copyright information in PMC

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