Jiangsu Key Laboratory of Molecular Imaging and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing 210009, China.
Eur J Radiol. 2012 Oct;81(10):2463-9. doi: 10.1016/j.ejrad.2011.10.008. Epub 2011 Nov 6.
Diffuse brain atrophy has been observed in cirrhotic patients and recent reports have revealed the persistence of cognitive impairment after clinical resolution of overt hepatic encephalopathy. We sought to explore the continued influence of overt hepatic encephalopathy on neurological function by measuring brain resting-state inherent connectivity, based on an investigation of structural abnormalities.
Neuropsychological tests and structural and functional magnetic resonance scanning were conducted in 20 healthy controls and 21 cirrhotic patients with a history of overt hepatic encephalopathy. The analysis of voxel-based morphometry and functional connectivity were performed to detect the alterations in brain structure and function, respectively.
Patients showed significantly worse performance in neuropsychological tests as compared with controls, despite apparently normal mental status. Analysis of voxel-based morphometry revealed a decrease in gray matter volume primarily in the midline regions, bilateral insular cortex and caudates, left parahippocampal gyrus, and right cerebellum posterior lobe, while the volume of the bilateral thalamus showed an increase. Of these regions, the posterior cingulate cortex with peak atrophy was selected as the origin for the analysis of functional connectivity. Typical patterns of a default mode network were identified in both groups. Decreased functional connectivity was found in the medial prefrontal gyrus, left inferior parietal lobule, and left middle temporal gyrus in the patients.
Both functional and structural impairments were evident after apparent recovery from overt hepatic encephalopathy, demonstrating that brain dysfunction induced by hepatic encephalopathy persisted after clinical resolution and provided a basis for further evolution of the disease.
在肝硬化患者中观察到弥漫性脑萎缩，最近的报告显示，在显性肝性脑病的临床缓解后，认知障碍仍然存在。我们试图通过测量脑静息状态固有连接，基于对结构异常的研究，来探索显性肝性脑病对神经功能的持续影响。
对 20 名健康对照者和 21 名有显性肝性脑病病史的肝硬化患者进行神经心理学测试和结构及功能磁共振扫描。进行基于体素形态测量和功能连接的分析，以分别检测脑结构和功能的改变。
与对照组相比，患者的神经心理学测试表现明显较差，尽管精神状态明显正常。基于体素形态测量分析显示，灰质体积减少主要发生在中线区域、双侧岛叶皮质和尾状核、左侧海马旁回和右侧小脑后叶，而双侧丘脑的体积增加。在这些区域中，后扣带回皮质（萎缩峰值所在的区域）被选为功能连接分析的起源。两组均确定了典型的默认模式网络模式。患者的内侧前额叶皮质、左侧顶下小叶和左侧颞中回的功能连接减少。
在显性肝性脑病明显缓解后，存在功能和结构损伤，表明肝性脑病引起的脑功能障碍在临床缓解后仍然存在，并为疾病的进一步发展提供了基础。
