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. 2025 Jan;15(1):e70240.
doi: 10.1002/brb3.70240.

Quantitative Assessment of Deep Gray Matter Susceptibility and Correlation With Cognition in Patients With Liver Cirrhosis

Wenjun Wu  1   2 , Yu Su  1 , Ziji Qin  3 , Jiamin Kang  4 , Dongqiao Xiang  1   2 , Dingxi Liu  1   2 , Chuansheng Zheng  1   2 , E Mark Haacke  5   6 , Lixia Wang  1   2
Affiliations

Quantitative Assessment of Deep Gray Matter Susceptibility and Correlation With Cognition in Patients With Liver Cirrhosis

Wenjun Wu et al. Brain Behav. 2025 Jan.

Abstract

Background and objectives: Accumulation of metals quantified by quantitative susceptibility mapping (QSM) in deep gray matter (DGM) and their impact on cognition have not been studied in patients with liver cirrhosis. This study aims to use QSM to investigate the association between DGM susceptibility and cognition in cirrhotic patients.

Methods: Thirty cirrhotic patients and 30 age-, gender-, and education-matched controls were imaged using a multiecho gradient-echo sequence for QSM analysis in a 3T scanner. The susceptibility values were determined for the caudate nucleus (CN), putamen (PU), globus pallidus (GP), thalamus (TH), red nucleus (RN), substantia nigra (SN), and dentate nucleus (DN). All subjects underwent number connection test A (NCT-A), digit substitution test (DST), and Montreal Cognitive Assessment (MoCA). Comparisons between the two groups and the correlation between the susceptibility values and neuropsychological scores were analyzed.

Results: The susceptibility values of bilateral CN, TH, and RN were significantly lower in cirrhotic patients. Cirrhotic patients exhibited significantly prolonged NCT-A time and decreased DST and MoCA scores. The NCT-A, DST, MoCA, and sub-domain scores were correlated with susceptibility values of RN, DN, SN, and CN, respectively. The susceptibility value of the left RN was a predictor variable for the DST, MoCA, and visuospatial-executive scores; those of the right CN and left RN were predictor variables for the naming score, and that of the left SN was an independent predictor variable for the language score.

Conclusions: Altered susceptibility values of DGM measured by QSM are potential quantitative indicators of cognitive impairment in cirrhotic patients.

Keywords: cognitive impairment; deep gray matter; liver cirrhosis; metal accumulation; quantitative susceptibility mapping.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Regions of interest (ROI) demarcated on the quantitative susceptibility mapping (QSM) images. 1 = caudate nucleus (CN); 2 = putamen (PU); 3 = globus pallidus (GP); 4 = thalamus (TH); 5 = substantia nigra (SN); 6 = red nucleus (RN); 7 = dentate nucleus (DN).
FIGURE 2
FIGURE 2
Representative QSM images of control (a,c) and liver cirrhosis (b,d). Liver cirrhosis exhibits a relatively lower magnetic susceptibility in basal ganglia and midbrain.
FIGURE 3
FIGURE 3
Correlation between blood ammonia level and susceptibility values in globus pallidus.
FIGURE 4
FIGURE 4
(a–f) Correlations between the susceptibility values of different DGM and the neuropsychological scores in the patients with liver cirrhosis. (g–l) MoCA sub‐domain analysis compares susceptibility values across different scores. *** = p < 0.05 between score 3 and scores 0, 1, 2; * = p < 0.05 between score 3 and score 0; # = p < 0.05 between score 2 and score 0; ^ = p < 0.05 between score 1 and score 0.
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