Qi Rongfeng, Zhang Long Jiang, Luo Song, Ke Jun, Kong Xiang, Xu Qiang, Liu Chang, Lu Heng, Lu Guang Ming
From the Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, 210002, China (RQ, LJZ, SL, JK, XK, QX, GML); Department of Gastroenterology, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, 210002, China (CL, HL).
Medicine (Baltimore). 2014 Dec;93(27):e227. doi: 10.1097/MD.0000000000000227.
To investigate the contribution of brain default mode network (DMN) in the early diagnosis of the minimal hepatic encephalopathy (MHE), the mildest form of HE from cirrhotic patients by using resting-state functional magnetic resonance imaging (rs-fMRI). This study was approved by the local ethical committee, and a written informed consent was obtained from each participant. A total of 103 cirrhotic patients (34 MHE, 69 non-HE) and 103 matched healthy controls underwent rs-fMRI scanning. The DMN correlation map was acquired by using unbiased seed-based functional connectivity analysis and compared among MHE patients, non-HE patients, and healthy controls with analysis of variance tests. Pearson correlation analysis was performed between the abnormal DMN connectivity and neuropsychological performances. Receiver operator characteristic (ROC) analysis was used to evaluate the contribution of DMN connectivity strength in the differential diagnosis between MHE and non-HE. Compared with the healthy controls, MHE and non-HE patients showed decreased DMN connectivity in medial prefrontal cortex (MPFC), left superior frontal gyrus (SFG), left temporal lobe, and bilateral middle temporal gyri (MTG). The MHE patients showed even more decreased connectivity in MPFC, left SFG, and right MTG when compared with non-HE patients. Pearson correlation analyses revealed that the decreased connectivity strength of some DMN regions correlated with patients' neuropsychological tests scores. Connectivity strength of the MPFC, right MTG, and left SFG could differentiate MHE from non-HE, of which the MPFC had the highest effectiveness (sensitivity = 81.5%, specificity = 70.4%). Cirrhotic patients had gradually reduced DMN functional connectivity from non-HE patients to MHE patients. DMN function, especially the MPFC, might be a useful imaging marker for differentiating MHE from cirrhotic patients.
为了研究大脑默认模式网络（DMN）在最小肝性脑病（MHE）早期诊断中的作用，MHE是肝硬化患者中最轻微的肝性脑病形式，本研究采用静息态功能磁共振成像（rs-fMRI）进行。本研究经当地伦理委员会批准，并获得每位参与者的书面知情同意。共有103例肝硬化患者（34例MHE，69例非肝性脑病）和103例匹配的健康对照者接受了rs-fMRI扫描。通过使用无偏倚的基于种子的功能连接分析获取DMN相关图，并通过方差分析在MHE患者、非肝性脑病患者和健康对照者之间进行比较。对异常DMN连接性与神经心理学表现进行Pearson相关分析。采用受试者操作特征（ROC）分析来评估DMN连接强度在MHE与非肝性脑病鉴别诊断中的作用。与健康对照者相比，MHE和非肝性脑病患者在内侧前额叶皮质（MPFC）、左侧额上回（SFG）、左侧颞叶和双侧颞中回（MTG）的DMN连接性降低。与非肝性脑病患者相比，MHE患者在MPFC、左侧SFG和右侧MTG的连接性降低更为明显。Pearson相关分析显示，一些DMN区域连接强度的降低与患者的神经心理学测试得分相关。MPFC、右侧MTG和左侧SFG的连接强度可将MHE与非肝性脑病区分开来，其中MPFC的有效性最高（敏感性 = 81.5%，特异性 = 70.4%）。肝硬化患者从非肝性脑病患者到MHE患者的DMN功能连接逐渐降低。DMN功能，尤其是MPFC，可能是区分MHE与肝硬化患者的有用影像学标志物。
