Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, 305 Zhongshan East Road, Xuanwu District, Nanjing, Jiangsu 210002, China.
Radiology. 2012 Nov;265(2):528-36. doi: 10.1148/radiol.12120185. Epub 2012 Sep 20.
To investigate patterns of whole-brain functional connectivity in patients with minimal hepatic encephalopathy (HE) by using functional magnetic resonance (MR) imaging.
This study was approved by the local institutional review board and was HIPAA compliant. All participants provided written informed consent. Neuropsychiatric tests including number connection test type A and digit symbol test were used to define minimal HE. Twenty-three patients with minimal HE and 25 age- and sex-matched healthy volunteers were included in this study. Resting-state functional MR imaging was performed by using a 3-T MR imaging unit. Functional connectivities between 90 pairs of cortical and subcortical regions in patients with minimal HE were compared with those in control participants, and significantly different connectivities were chosen as connectivities of interest (COIs). Correlations between neuropsychiatric tests and correlation coefficients of COIs were calculated.
Among the 51 COIs that were significantly different in patients with minimal HE from those in control participants, 44 connectivities were weaker in patients with minimal HE. All 22 COIs related to subcortical regions of interest (bilateral putamen, pallidum, and thalamus) were weaker in patients with minimal HE. Of 29 cortical COIs, 22 connectivities were weaker and seven were stronger in patients with minimal HE. Nearly all COIs with significant differences correlated with digital symbol test scores (P<.05, false discovery rate corrected). No correlation was found among blood ammonia level, Child-Pugh scores, or any COIs in patients with minimal HE (P>.05, false discovery rate corrected).
Widespread cortical and subcortical network connectivity changes that correlated with neuropsychologic impairment were found in patients with minimal HE. In particular, impairment in the basal ganglia-thalamocortical circuit could play an important role in mediating neurocognitive dysfunction, especially for psychomotor speed and attention deficits in patients with minimal HE.
通过功能磁共振成像（functional magnetic resonance imaging，fMRI）研究轻微肝性脑病（minimal hepatic encephalopathy，HE）患者全脑功能连接的模式。
本研究经当地机构审查委员会批准，并符合 HIPAA 规定。所有参与者均提供书面知情同意书。使用数字连接测试 A 型和数字符号测试对神经精神病学测试进行评估，以定义轻微 HE。本研究纳入 23 例轻微 HE 患者和 25 例年龄和性别匹配的健康志愿者。使用 3.0T MR 成像仪进行静息态功能磁共振成像。将轻微 HE 患者与对照组之间的 90 对皮质和皮质下区域的功能连接进行比较，并选择差异显著的连接作为感兴趣的连接（connectivities of interest，COIs）。计算神经精神病学测试之间的相关性和 COIs 的相关系数。
在轻微 HE 患者与对照组之间存在显著差异的 51 个 COIs 中，44 个连接较弱。所有与皮质下感兴趣区（双侧壳核、苍白球和丘脑）相关的 22 个 COIs 在轻微 HE 患者中均较弱。在 29 个皮质 COIs 中，22 个连接较弱，7 个连接较强。具有显著差异的 COIs 几乎都与数字符号测试评分相关（P<.05，经假发现率校正）。在轻微 HE 患者中，未发现血氨水平、Child-Pugh 评分或任何 COIs 之间存在相关性（P>.05，经假发现率校正）。
在轻微 HE 患者中发现了与神经认知障碍相关的广泛皮质和皮质下网络连接变化。特别是基底节-丘脑皮质回路的损伤可能在介导神经认知功能障碍中发挥重要作用，尤其是在轻微 HE 患者的运动速度和注意力缺陷方面。
