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Updated: Sep 19, 2025
Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
Published on: April 23, 2021
Associations among neuropsychological performance, brain structural alterations, and glymphatic function in patients
Chao Ju1, Longtao Yang2, Zhongshang Dai3
1Department of Radiology, The Second Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China.
Abstract:
Brain anatomical alterations in gray matter(GM), white matter(WM), and glymphatic system(GS) in patients with hepatitis B cirrhosis(HBC) with minimal hepatic encephalopathy(MHE) remain to be clarified. A total of 33 healthy controls and 37 patients with treatment-native primary HBC (further subdivided into HBC in MHE group[MHE] and HBC in non-MHE group[NMHE]) participated in neuroimaging study with three-dimensional T1 and a half q-space Cartesian grid diffusion model. Group differences in regional GM volume(GMV) were assessed using voxel-based morphometry(VBM) analysis. Differences in WM diffusion metrics were compared using tract-based spatial statistics(TBSS) analysis. Diffusion tensor image analysis along the perivascular space(DTI-ALPS) was employed to evaluate GS function. Compared to healthy control group (HC), GMV was reduced in MHE group, mainly in the vermis, bilateral pallidum, and right putamen, but was increased in right lateral geniculate thalamus(Thal_LGN_R) and left pulvinar medial thalamus(Thal_PuM_L). MHE patients displayed greater isotropic volume fraction(ISOVF) in the right sagittal stratum, right superior longitudinal fasciculus, left fornix(cres)/stria terminalis, left corticospinal tract, left cerebral peduncle, and left cingulum (hippocampus) than HC. DTI-ALPS was significantly downregulated in MHE patients. It revealed cortical changes, low-grade WM edema, and GS disorders at the early stage of chronic HBC, which will aid in MHE identification.
Insights
Minimal hepatic encephalopathy in hepatitis B cirrhosis patients shows brain alterations. Early identification may be aided by detecting gray matter changes, white matter edema, and glymphatic system dysfunction.
Area of Science:
- Neuroimaging
- Hepatology
- Neurology
Background:
- Hepatitis B cirrhosis (HBC) can lead to minimal hepatic encephalopathy (MHE), but the underlying brain changes are not fully understood.
- Understanding brain anatomical alterations in gray matter (GM), white matter (WM), and the glymphatic system (GS) is crucial for early MHE detection in HBC patients.
Purpose of the Study:
- To investigate and clarify brain anatomical alterations in GM, WM, and GS in patients with HBC and MHE.
- To differentiate neuroimaging findings between HBC patients with and without MHE.
Main Methods:
- Utilized 3D T1 and a half q-space Cartesian grid diffusion models for neuroimaging.
- Employed voxel-based morphometry (VBM) for GM volume analysis and tract-based spatial statistics (TBSS) for WM diffusion metrics.
- Applied diffusion tensor image analysis along the perivascular space (DTI-ALPS) to assess GS function.
Main Results:
- MHE patients showed reduced GM volume in specific brain regions (vermis, pallidum, putamen) and increased volume in others (thalamus).
- MHE patients exhibited greater isotropic volume fraction (ISOVF) in several WM tracts compared to healthy controls.
- DTI-ALPS analysis revealed significantly downregulated GS function in MHE patients.
Conclusions:
- Early-stage chronic HBC with MHE is associated with cortical changes, low-grade WM edema, and glymphatic system disorders.
- These neuroimaging findings can potentially aid in the early identification of MHE in HBC patients.
