1H-MR Spectroscopy, Magnetization Transfer, and Diffusion-Weighted Imaging in Alcoholic and Nonalcoholic Patients with Cirrhosis with Hepatic Encephalopathy
F. Miesea,
G. Kircheisb,
H.J. Wittsacka,
F. Wenserskia,
J. Hemkerb,
U. Möddera,
D. Häussingerb and
M. Cohnena
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
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Fig 1. Graph shows hepatic encephalopathy grading and occipital white matter Glx/Cr in mean values; whiskers show SD. White matter Glx of alcoholics, graded mHE, HE 1, and HE 2 and white matter Glx of nonalcoholics with overt hepatic encephalopathy (HEO) are elevated, compared with that of controls (Co) (P < 0.05; Mann-Whitney U test).
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Fig 2. Graph shows hepatic encephalopathy-grading and occipital white matter MTR in mean values; whiskers show SD. White matter MTR of alcoholics, graded any hepatic encephalopathy, and white matter MTR of nonalcoholics with overt hepatic encephalopathy (HRO) are reduced, compared with that of controls (C0) (P < 0.05; Mann-Whitney U test).
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Fig 3. A, Nonalcoholics: occipital white matter Glx/Cr and MTR. Graph shows linear regression analysis (r2=0.48) and 95% predictive interval of means.
B, Alcoholics: occipital white matter Glx/Cr and MTR. Graph shows linear regression analysis (r2 = 0.07) and 95% predictive interval of means.
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Fig 4. A, Nonalcoholics: occipital white matter Glx/Cr and mIns/Cr. Graph shows linear regression analysis (r2 = 0.34) and 95% predictive interval of means.
B, Alcoholics: occipital white matter Glx/Cr and mIns/Cr. Graph shows linear regression analysis (r2=0.00) and 95% predictive interval of means.
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Fig 5. MR Spectra of posterior NAWM in a healthy control (A, patient 11), a nonalcoholic patient with cirrhosis (B, patient 55) with overt hepatic encephalopathy, and an alcoholic patient with cirrhosis (C, patient 59). Arrows indicate alterations in the patient’s spectrum, compared with that of the control group. Control (A): mIns/Cr, 0.926; NAA/Cr, 1.952; Cho/Cr, 0.301; Glx/Cr, 1.442. Nonalcoholic patient with cirrhosis (B): mIns/Cr, 0.038; NAA/Cr, 2.129; Cho/Cr, 0.255; Glx/Cr, 3.307. Alcoholic patient with cirrhosis (C): mIns/Cr, 0.260; NAA/Cr, 1.722; Cho/Cr, 0.249; Glx/Cr, 1.784.
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Fig 6. MTR map (width, 100%; center, 50%). A, Healthy volunteer (subject 8). B, Nonalcoholic patient with cirrhosis with HE 2 (subject 57). C, Alcoholic patient with cirrhosis with HE 2 (subject 59). MTR of volunteer (A): thalamus, 39.1%; pallidum, 36.4%; putamen, 37.3%; caudate, 37.5%. The following data refer to means of right and left side of the brain. MTR of nonalcoholic patients with cirrhosis (B): thalamus, 35.7%; pallidum, 27.0%; putamen, 31.1%; caudate, 27.7%. MTR of alcoholic patients with cirrhosis (C): thalamus, 34.8%; pallidum, 29.7%; putamen, 28.4%; caudate, 27.5%
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Fig 7. ADC map (width, 400%; center, 200%). A, Healthy volunteer (subject 14). B, Nonalcoholic patient with cirrhosis with HE 2 (subject 47). C, Alcoholic patient with cirrhosis and HE 2 (subject 50). ADC of volunteer (A): thalamus, 73.6; NAWM, 83.3. The following data refer to means of right and left side of the brain. ADC of nonalcoholic patients with cirrhosis (B): thalamus, 87.9; NAWM, 101.4. ADC of alcoholic patients with cirrhosis (C): thalamus, 80.6; NAWM, 108.
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