Servei de Medicina Interna-Hepatologia, Hospital Vall d'Hebron, Vall d'Hebron Institut of Research, Barcelona, Spain.
Neurochem Int. 2011 Dec;59(8):1175-80. doi: 10.1016/j.neuint.2011.09.003. Epub 2011 Sep 14.
Acute liver failure (ALF) is frequently complicated by the development of brain edema that can lead to intracranial hypertension and severe brain injury. Neuroimaging techniques allow a none-invasive assessment of brain tissue and cerebral hemodynamics by means of transcranial Doppler ultrasonography, magnetic resonance and nuclear imaging with radioligands. These methods have been very helpful to unravel the pathogenesis of this process and have been applied to patients and experimental models. They allow monitoring the outcome of patients with ALF and neurological manifestations. The increase in brain water can be detected by observing changes in brain volume and disturbances in diffusion weighted imaging. Neurometabolic changes are detected by magnetic resonance spectroscopy, which provides a pattern of abnormalities characterized by an increase in glutamine and a decrease in myo-inositol. Disturbances in cerebral blood flow are depicted by SPECT or PET and can be monitored and the bedside by assessing the characteristics of the waveform provided by transcranial Doppler ultrasonography. Neuroimaging methods, which are rapidly evolving, will undoubtedly lead to future diagnostic and therapeutic progress that could be very helpful for patients with ALF.
急性肝衰竭（ALF）常并发脑水肿，可导致颅内压升高和严重脑损伤。神经影像学技术通过经颅多普勒超声、磁共振和放射性配体核成像，实现了对脑组织和脑血流动力学的非侵入性评估。这些方法对于阐明该过程的发病机制非常有帮助，并已应用于患者和实验模型。它们可以监测具有神经表现的 ALF 患者的预后。通过观察脑体积的变化和弥散加权成像的紊乱，可以检测到脑水的增加。磁共振波谱可以检测到神经代谢变化，其特征为谷氨酰胺增加和肌醇减少。通过单光子发射计算机断层扫描或正电子发射断层扫描可以描绘出脑血流的紊乱，并可以通过评估经颅多普勒超声提供的波形特征来进行床边监测。神经影像学方法正在迅速发展，无疑将为未来的诊断和治疗进展提供帮助，这对 ALF 患者非常有帮助。
