TY - JOUR
T1 - The development of low-grade cerebral edema in cirrhosis is supported by the evolution of 1H-magnetic resonance abnormalities after liver transplantation
AU - Córdoba, Juan
AU - Alonso, Juli
AU - Rovira, Alex
AU - Jacas, Carlos
AU - Sanpedro, Francesc
AU - Castells, Lluís
AU - Vargas, Víctor
AU - Margarit, Carles
AU - Kulisewsky, Jaime
AU - Esteban, Rafael
AU - Guardia, Jaume
PY - 2001/12/3
Y1 - 2001/12/3
N2 - Background/Aims: Liver failure may cause brain edema through an increase in brain glutamine. However, usually standard neuroimaging techniques do not detect brain edema in cirrhosis. We assessed magnetization transfer ratio and 1H-magnetic resonance (MR) spectroscopy before and after liver transplantation to investigate changes in brain water content in cirrhosis. Methods: Non-alcoholic cirrhotics without overt hepatic encephalopathy (n = 24) underwent 1H-MR of the brain and neuropsychological tests. 1H-MR results were compared with those of healthy controls (n = 10). In a subgroup of patients (n = 11), the study was repeated after liver transplantation. Results: Cirrhotic patients showed a decrease in magnetization transfer ratio (31.5 ± 3.1 vs. 37.1 ± 1.1, P < 0.01) and an increase in glutamine/glutamate signal (2.22 ± 0.47 vs. 1.46 ± 0.26, P < 0.01). The increase in glutamine/glutamate signal was correlated to the decrease in magnetization transfer ratio and to neuropsychological function. Following liver transplantation, there was a progressive normalization of magnetization transfer ratio, glutamine/glutamate signal and neuropsychological function. Accordingly, correlations between these variables were lost after liver transplantation. Conclusions: Cirrhotic patients show reversible changes in magnetization transfer ratio that are compatible with the development of low-grade cerebral edema. Minimal hepatic encephalopathy and low-grade cerebral edema appear to be the consequences of the metabolism of ammonia in the brain. © 2001 European Association for the Study of the Liver. Published by Elsevier Science B.V. All rights reserved.
AB - Background/Aims: Liver failure may cause brain edema through an increase in brain glutamine. However, usually standard neuroimaging techniques do not detect brain edema in cirrhosis. We assessed magnetization transfer ratio and 1H-magnetic resonance (MR) spectroscopy before and after liver transplantation to investigate changes in brain water content in cirrhosis. Methods: Non-alcoholic cirrhotics without overt hepatic encephalopathy (n = 24) underwent 1H-MR of the brain and neuropsychological tests. 1H-MR results were compared with those of healthy controls (n = 10). In a subgroup of patients (n = 11), the study was repeated after liver transplantation. Results: Cirrhotic patients showed a decrease in magnetization transfer ratio (31.5 ± 3.1 vs. 37.1 ± 1.1, P < 0.01) and an increase in glutamine/glutamate signal (2.22 ± 0.47 vs. 1.46 ± 0.26, P < 0.01). The increase in glutamine/glutamate signal was correlated to the decrease in magnetization transfer ratio and to neuropsychological function. Following liver transplantation, there was a progressive normalization of magnetization transfer ratio, glutamine/glutamate signal and neuropsychological function. Accordingly, correlations between these variables were lost after liver transplantation. Conclusions: Cirrhotic patients show reversible changes in magnetization transfer ratio that are compatible with the development of low-grade cerebral edema. Minimal hepatic encephalopathy and low-grade cerebral edema appear to be the consequences of the metabolism of ammonia in the brain. © 2001 European Association for the Study of the Liver. Published by Elsevier Science B.V. All rights reserved.
KW - 1 H magnetic resonance spectroscopy
KW - Brain edema
KW - Cirrhosis
KW - Hepatic encephalopathy
KW - Liver transplant
KW - Magnetization transfer imaging
U2 - https://doi.org/10.1016/S0168-8278(01)00181-7
DO - https://doi.org/10.1016/S0168-8278(01)00181-7
M3 - Article
VL - 35
SP - 598
EP - 604
JO - Journal of Hepatology
JF - Journal of Hepatology
SN - 0168-8278
ER -