定量磁化率映射显示轻微型肝性脑病的脑铁积累:与神经认知变化的关联。
Quantitative susceptibility mapping reveals brain iron accumulation in minimal hepatic encephalopathy: associations with neurocognitive changes.
机构信息
Department of Stomatology, Fujian Medical University Union Hospital, Fuzhou, 350001, China.
Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, 350001, China.
出版信息
Metab Brain Dis. 2024 Nov 20;40(1):22. doi: 10.1007/s11011-024-01440-6.
Brain iron deposition is correlated with minimal hepatic encephalopathy (MHE). This study aimed to investigate the pattern of altered iron distribution, using quantitative susceptibility mapping (QSM), and to clarify the relationship between iron deposition and neurocognitive changes in MHE. We enrolled 32 cirrhotic patients without MHE (NHE), 21 cirrhotic patients with MHE, and 24 healthy controls, and used the Psychometric Hepatic Encephalopathy Score (PHES) to assess neurocognitive function. All participants underwent magnetic resonance scans with a gradient-echo sequence reconstructing for QSM. We performed voxel-wise and region-of-interest (ROI)-wise analyses to investigate the QSM difference across three groups and to examine the relationship between susceptibility value and PHES. MHE patients exhibited increased susceptibility value in widespread brain areas (family-wise error (FWE)-corrected P < 0.05), which was located mainly in cognition-related regions (such as the prefrontal lobe, precuneus, inferior parietal lobule, insula, thalamus, and superior longitudinal fasciculus), sensorimotor regions (such as the precentral/postcentral gyrus, superior parietal lobule, and posterior corona radiata), visual regions (such as the occipital cortex and posterior thalamic radiation), and auditory regions (such as the temporal lobe). NHE patients also followed a trend of increasing susceptibility in the scattered brain regions, but which did not reach statistical significance (FWE-corrected P > 0.05). We observed negative correlations between cirrhotic patients' PHES and regional susceptibility values (FWE-corrected P < 0.05). Brain iron accumulation (measured using QSM) contributes to cognitive impairments in MHE patients. QSM could provide new insights into the pathogenesis of MHE and facilitate monitoring disease development.
脑铁沉积与轻微肝性脑病(MHE)相关。本研究旨在通过定量磁化率映射(QSM)研究铁分布改变的模式,并阐明 MHE 中铁沉积与神经认知变化的关系。我们纳入了 32 名无 MHE(NHE)的肝硬化患者、21 名 MHE 肝硬化患者和 24 名健康对照者,并使用精神测肝性脑病评分(PHES)评估神经认知功能。所有参与者均进行了带有梯度回波序列重建的 QSM 磁共振扫描。我们进行了体素和感兴趣区(ROI)分析,以研究三组间的 QSM 差异,并研究磁化率值与 PHES 的关系。MHE 患者在广泛的脑区显示出磁化率值增加(经家族-wise 错误校正(FWE)的 P < 0.05),这些区域主要位于认知相关区域(如前额叶、楔前叶、下顶叶、岛叶、丘脑和上纵束)、感觉运动区域(如中央前/后回、上顶叶和后放射冠)、视觉区域(如枕叶和后丘脑辐射)和听觉区域(如颞叶)。NHE 患者在分散的脑区也有磁化率增加的趋势,但未达到统计学意义(经 FWE 校正的 P > 0.05)。我们观察到肝硬化患者的 PHES 与局部磁化率值之间存在负相关(经 FWE 校正的 P < 0.05)。脑铁积累(通过 QSM 测量)导致 MHE 患者的认知障碍。QSM 可为 MHE 的发病机制提供新的见解,并有助于监测疾病的发展。