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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 27:1019-1026, May 2006
© 2006 American Society of Neuroradiology

BRAIN

¹H-MR Spectroscopy, Magnetization Transfer, and Diffusion-Weighted Imaging in Alcoholic and Nonalcoholic Patients with Cirrhosis with Hepatic Encephalopathy

F. Miese^a, G. Kircheis^b, H.J. Wittsack^a, F. Wenserski^a, J. Hemker^b, U. Mödder^a, D. Häussinger^b and M. Cohnen^a

^a Institute of Diagnostic Radiology, University Hospital Düsseldorf, MNR Clinic, Moorenstr 5, 40225 Düsseldorf, Germany
^b Department of Internal Medicine, Division of Gastroenterology, Hepatology, and Infectious Diseases, University Hospital Düsseldorf, MNR Clinic, Moorenstr 5, 40225 Düsseldorf, Germany

Please address correspondence to: M. Cohnen, MD, University Hospital Düsseldorf, Institute of Diagnostic Radiology, MNR Clinic, Moorenstr 5, 40225 Düsseldorf

PURPOSE: Mild swelling of astrocytes is proposed as a key event in the pathogenesis of hepatic encephalopathy. Proton MR spectroscopy (¹H-MR spectroscopy), diffusion-weighted imaging (DWI), and magnetization transfer imaging were performed in patients with alcoholic and nonalcoholic liver cirrhosis and correlated with different clinical stages of hepatic encephalopathy to assess alterations in cerebral water metabolism in different subgroups of patients with cirrhosis.

MATERIAL AND METHODS: Forty-five patients (26 alcoholics, 19 nonalcoholics [due to hepatitis C (n = 9), hemochromatosis (n = 2), primary chronic cholangitis (n = 2), hepatitis B (n = 1), Wilson disease (n = 1), cryptogenic cirrhosis (n = 4)]) and 18 controls underwent ¹H-MR spectroscopy, magnetization transfer imaging, and DWI of the basal ganglia and normally appearing occipital white matter (NAWM). N-acetylaspartate (NAA), choline (Cho), myo-inositol (mIns), and glutamine/glutamate (Glx) relative to creatine (Cr), the apparent diffusion coefficients (ADC), and the magnetization transfer ratios (MTR) were correlated to the neuropsychologic status, which was assessed by computerized psychometry and mental state grading, according to the West Haven criteria.

RESULTS: Compared with controls, nonalcoholic subjects exhibited a gradual increase of Glx/Cr in the basal ganglia and NAWM; a decrease in mIns/Cr; a significant decrease of MTR in the thalamus, the putamen, the pallidum, and NAWM; and an increase in the ADC of the NAWM with increasing hepatic encephalopathy severity. In alcoholics, mIns/Cr of the basal ganglia and the NAWM, Cho/Cr of the basal ganglia, and MTR of all assessed regions were decreased. Glx/Cr of the basal ganglia and of the NAWM was increased, compared with that of controls; but no correlation to the clinical hepatic encephalopathy grading was found. ADC did not change significantly between the groups.

CONCLUSIONS: Apart from a typical pattern of ¹H-MR spectroscopy alterations in hepatic encephalopathy, a gradual decrease in MTR and an increase of ADC was found correlating to clinical grading of hepatic encephalopathy in nonalcoholic patients with cirrhosis. In alcoholic patients with hepatic encephalopathy, there was no such correlation. Abnormalities detected by MR imaging may hint at different pathways of brain damage in alcohol-induced liver disease.

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