Neuroimaging in hepatic encephalopathy

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Presentation transcript:

Neuroimaging in hepatic encephalopathy Charmaine A. Stewart, Martin Reivich, Michael R. Lucey, Gregory J. Gores Clinical Gastroenterology and Hepatology Volume 3, Issue 3, Pages 197-207 (March 2005) DOI: 10.1016/S1542-3565(04)00531-2 Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 1 The major subcortical structures in relationship to the cortex and skull. Reprinted with permission.84 Clinical Gastroenterology and Hepatology 2005 3, 197-207DOI: (10.1016/S1542-3565(04)00531-2) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 2 Loci of minima identified by statistical parametric mapping. Omnibus t test at the P < .01 threshold is used to show significance at P < .01. Stippled areas refer to the results of single testing that the number of pixels outside of the threshold P < .01 is owing to chance. There is a significant decrease in the uptake of FDG in the inferior and anterior cingulate gyrus. The cingulate is represented by the shaded area in the midline and extends from the bottom right up 9 planes. Pixels within this area show regions of decreased FDG uptake, indicating low glucose metabolism. Reprinted with permission.45 Copyright © 1993 American Association of Liver Disease. Clinical Gastroenterology and Hepatology 2005 3, 197-207DOI: (10.1016/S1542-3565(04)00531-2) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 3 Analyses of benzodiazepine binding in patients with hepatic failure (top row), control (middle row), and voxel-by-voxel comparison of between-group differences (bottom row). The greatest changes in distribution volume of flumazenil was seen in the cerebellum, whereas the highest t values are in the ventral thalamus/hypothalamus (middle column) and cerebellum. The voxel-by-voxel changes, however, were not found to be significant. Reprinted with permission.10 Copyright © 1997 American Association of Liver Disease. Clinical Gastroenterology and Hepatology 2005 3, 197-207DOI: (10.1016/S1542-3565(04)00531-2) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 4 Brain MRI of patients with HE. Clinical Gastroenterology and Hepatology 2005 3, 197-207DOI: (10.1016/S1542-3565(04)00531-2) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 5 Metabolite ratios in patients with HE and normal volunteers. Patients with subclinical HE had a decreased myo-inositol/Cr ratio (P < .001) and choline/Cr ratio (P < .001), and a high Glx/Cr ratio (P < .005). Reprinted with permission.70 Clinical Gastroenterology and Hepatology 2005 3, 197-207DOI: (10.1016/S1542-3565(04)00531-2) Copyright © 2005 American Gastroenterological Association Terms and Conditions