Kale Ravindra A, Gupta Rakesh K, Saraswat Vivek A, Hasan Khader M, Trivedi Richa, Mishra Asht M, Ranjan Piyush, Pandey Chandra M, Narayana Ponnada A
Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Hepatology. 2006 Apr;43(4):698-706. doi: 10.1002/hep.21114.
Brain water may increase in hepatic encephalopathy (HE). Diffusion tensor imaging was performed in patients with cirrhosis with or without HE to quantify the changes in brain water diffusivity and to correlate it with neuropsychological (NP) tests. Thirty-nine patients with cirrhosis, with minimal (MHE) or overt HE, were studied and compared to 18 controls. Mean diffusivity (MD) and fractional anisotropy (FA) were calculated in corpus callosum, internal capsule, deep gray matter nuclei, periventricular frontal, and occipital white matter regions in both cerebral hemispheres. The MD and FA values from different regions in different groups were compared using analysis of variance and Spearman's rank correlation test. In 10 patients with MHE, repeat studies were performed after 3 weeks of lactulose therapy to look for any change in MD, FA, and NP scores. Significantly increased MD was found with insignificant changes in FA in various regions of brain in patients with MHE or HE compared with controls, indicating an increase in interstitial water in the brain parenchyma without any microstructural changes. A significant correlation was found between MD values from corpus callosum, internal capsule, and NP test scores. After therapy, MD values decreased significantly and there was a corresponding improvement in NP test scores. Further analysis showed that MD values were different for different grades of minimal or overt HE. In conclusion, the increase in MD with no concomitant changes in FA in cirrhosis with minimal or early HE indicates the presence of reversible interstitial brain edema.
肝性脑病（HE）时脑含水量可能增加。对伴有或不伴有HE的肝硬化患者进行弥散张量成像，以量化脑水扩散率的变化，并将其与神经心理学（NP）测试相关联。研究了39例伴有轻微（MHE）或显性HE的肝硬化患者，并与18名对照者进行比较。计算双侧大脑半球胼胝体、内囊、深部灰质核、脑室周围额叶和枕叶白质区域的平均扩散率（MD）和分数各向异性（FA）。使用方差分析和Spearman秩相关检验比较不同组不同区域的MD和FA值。对10例MHE患者在乳果糖治疗3周后进行重复研究，以观察MD、FA和NP评分的任何变化。与对照组相比，MHE或HE患者大脑各区域MD显著增加，而FA无显著变化，表明脑实质间质水增加但无任何微观结构变化。在胼胝体、内囊的MD值与NP测试评分之间发现显著相关性。治疗后，MD值显著下降，NP测试评分相应改善。进一步分析表明，不同程度的轻微或显性HE的MD值不同。总之，在轻微或早期HE的肝硬化中，MD增加而FA无伴随变化表明存在可逆性间质脑水肿。
