Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, China.
PLoS One. 2012;7(7):e42016. doi: 10.1371/journal.pone.0042016. Epub 2012 Jul 25.
Little is known about how spontaneous brain activity progresses from non-hepatic encephalopathy (non-HE) to minimal HE (MHE). The purpose of this study was to evaluate the evolution pattern of spontaneous brain activities in cirrhotic patients using resting-state fMRI with a regional homogeneity (ReHo) method.
METHODOLOGY/PRINCIPAL FINDINGS: Resting-state fMRI data were acquired in 47 cirrhotic patients (minimal HE [MHE], n = 20, and non-HE, n = 27) and 25 age-and sex-matched healthy controls. The Kendall's coefficient of concordance (KCC) was used to measure the regional homogeneity. The regional homogeneity maps were compared with ANOVA tests among MHE, non-HE, and healthy control groups and t-tests between each pair in a voxel-wise way. Correlation analyses were performed to explore the relationships between regional ReHo values and Child-Pugh scores, number connection test type A (NCT-A), digit symbol test (DST) scores, venous blood ammonia levels. Compared with healthy controls, both MHE and non-HE patients showed decreased ReHo in the bilateral frontal, parietal and temporal lobes and increased ReHo in the bilateral caudate. Compared with the non-HE, MHE patients showed decreased ReHo in the bilateral precuneus, cuneus and supplementary motor area (SMA). The NCT-A of cirrhotic patients negatively correlated with ReHo values in the precuneus, cuneus and lingual gyrus. DST scores positively correlated with ReHo values in the cuneus, precuneus and lingual gyrus, and negatively correlated with ReHo values in the bilateral caudate (P<0.05, AlphaSim corrected).
CONCLUSIONS/SIGNIFICANCE: Diffused abnormal homogeneity of baseline brain activity was nonspecific for MHE, and only the progressively decreased ReHo in the SMA and the cuneus, especially for the latter, might be associated with the development of MHE. The ReHo analysis may be potentially valuable for detecting the development from non-HE to MHE.
对于自发性脑活动如何从不肝性脑病（非 HE）进展到轻微肝性脑病（MHE），我们知之甚少。本研究旨在使用静息态 fMRI 中的局部一致性（ReHo）方法评估肝硬化患者的自发性脑活动的演变模式。
方法/主要发现：采集了 47 例肝硬化患者（MHE，n = 20，非 HE，n = 27）和 25 名年龄和性别匹配的健康对照者的静息态 fMRI 数据。使用 Kendall 一致性系数（KCC）来测量区域同质性。采用方差分析（ANOVA）比较 MHE、非 HE 和健康对照组之间的 ReHo 图，并用 t 检验比较两两之间的差异。采用相关性分析探讨区域 ReHo 值与 Child-Pugh 评分、数字连接测试 A（NCT-A）、数字符号测试（DST）评分、静脉血氨水平之间的关系。与健康对照组相比，MHE 和非 HE 患者双侧额叶、顶叶和颞叶的 ReHo 值降低，双侧尾状核的 ReHo 值升高。与非 HE 相比，MHE 患者双侧楔前叶、楔叶和辅助运动区（SMA）的 ReHo 值降低。肝硬化患者的 NCT-A 与楔前叶、楔叶和舌回的 ReHo 值呈负相关。DST 评分与楔叶、楔前叶和舌回的 ReHo 值呈正相关，与双侧尾状核的 ReHo 值呈负相关（P<0.05，经 AlphaSim 校正）。
结论/意义：基线脑活动的弥散性异常同质性对 MHE 不具有特异性，仅 SMA 和楔叶的 ReHo 值逐渐降低，特别是后者，可能与 MHE 的发生发展有关。ReHo 分析可能对检测非 HE 向 MHE 的发展具有潜在价值。
