Vol 46, No 5 (2012)

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Does magnetic resonance spectroscopy identify patients with minimal hepatic encephalopathy?

Irena Ciećko-Michalska1, Tomasz Dziedzic2, Robert Banyś3, Magdalena Senderecka4, Marek Binder4, Mirosław Wyczesany4, Jakub Szewczyk4, Jan Wójcik4, Agnieszka Słowik4, Tomasz Mach1
DOI: 10.5114/ninp.2012.31353
Neurol Neurochir Pol 2012;46(5):436-442.

Abstract

Background and purpose

The results of a few studies suggest that magnetic resonance spectroscopy of the brain could allow detection of minimal hepatic encephalopathy. The goal of this study was to assess the ability of magnetic resonance spectroscopy to differentiate between cirrhotic patients with and without minimal hepatic encephalopathy.

Material and methods

Localized magnetic resonance spectroscopy was performed in the basal ganglia, occipital gray matter and frontal white matter in 46 patients with liver cirrhosis without overt encephalopathy and in 45 controls. Neurological and neuropsychological examination was performed in each participant.

Results

The patients with liver cirrhosis had a decreased ratio of myoinositol to creatine in occipital gray matter and frontal white matter (mean: 0.17 ± 0.05 vs. 0.20 ± 0.04, p = 0.01 and 0.15 ± 0.05 vs. 0.19 ± 0.04, p < 0.01, respectively) and a decreased ratio of choline to creatine in occipital gray matter (mean: 0.32 ± 0.07 vs. 0.36 ± 0.08, p = 0.03). Minimal hepatic encephalopathy was diagnosed in 7 patients. Metabolite ratios did not differ significantly between patients with and without minimal hepatic encephalopathy. Metabolite ratios did not differ significantly between patients with Child-Pugh A and those with Child-Pugh B.

Conclusions

Magnetic resonance spectroscopy does not allow accurate diagnosis of minimal hepatic encephalopathy. A similar profile of metabolites in the brain is observed in cirrhotic patients without cognitive impairment.

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Neurologia i Neurochirurgia Polska