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PerAF-based resting-state fMRI classifier for minimal hepatic encephalopathy
Yunli Zhang1,2, Zhai Huang1, Bin Qin3
1Department of Intensive Care Unit, Guangxi Academy of Medical Sciences, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
Background:
Minimal hepatic encephalopathy (MHE) is a common cognitive impairment in patients with end-stage liver cirrhosis. However, the selection of sensitive biomarkers and the establishment of reliable diagnostic methods are currently challenging. We aimed to explore the abnormal spontaneous brain activity in patients with MHE and evaluate the clinical diagnostic value of four indicators for MHE using the support vector machine (SVM) method.
Methods:
A total of 45 MHE patients and 40 healthy controls were enrolled. Amplitude of low frequency fluctuation (ALFF), fractional amplitude of low frequency fluctuation (fALFF), percentage amplitude of low frequency fluctuation (PerAF), and regional homogeneity (ReHo) were used to evaluate local spontaneous brain activity. SVM analysis was used to construct the classification model and evaluate the diagnostic value.
Results:
Two-sample t-test and SVM analysis showed that, compared with the healthy control group, MHE patients had decreased ALFF values in the left angular gyrus, right inferior temporal gyrus, left postcentral gyrus, precentral gyrus, and right supplementary motor area. These regions indicated moderate classification efficacy (AUC = 0.75). Decreased ReHo metrics in the right anterior cingulate and paracingulate gyri also showed general discriminative power (AUC = 0.72). fALFF metrics, whether analyzed independently or combined with other indicators, exhibited limited classification performance (AUC < 0.70). Decreased PerAF metrics in the right superior parietal lobule, right dorsolateral prefrontal cortex, and right middle frontal gyrus achieved a good classification accuracy rate (AUC value 0.83; accuracy 81.18%; sensitivity 75.56%; specificity 87.50%), outperforming other functional metrics.
Conclusion:
We found that decreased mean PerAF in the right supramarginal gyrus, right dorsolateral superior frontal gyrus, and right middle frontal gyrus may serve as potential neuroimaging indicators for early identification of cognitive impairment in MHE patients, providing critical evidence for clinical screening protocols.
Insights
Percentage amplitude of low frequency fluctuation (PerAF) shows promise for diagnosing minimal hepatic encephalopathy (MHE). This neuroimaging marker aids in the early identification of cognitive impairment in liver cirrhosis patients.
Area of Science:
- Neuroimaging
- Medical Diagnostics
- Biomarker Discovery
Background:
- Minimal hepatic encephalopathy (MHE) is a prevalent cognitive impairment in patients with end-stage liver cirrhosis.
- Accurate diagnosis of MHE is challenging due to the lack of sensitive biomarkers and reliable diagnostic methods.
- Understanding abnormal spontaneous brain activity is crucial for MHE diagnosis.
Purpose of the Study:
- To investigate abnormal spontaneous brain activity in MHE patients.
- To evaluate the diagnostic value of four neuroimaging indicators (ALFF, fALFF, PerAF, ReHo) for MHE using Support Vector Machine (SVM).
- To identify potential biomarkers for early MHE detection.
Main Methods:
- Recruited 45 MHE patients and 40 healthy controls.
- Measured local spontaneous brain activity using Amplitude of Low Frequency Fluctuation (ALFF), Fractional Amplitude of Low Frequency Fluctuation (fALFF), Percentage Amplitude of Low Frequency Fluctuation (PerAF), and Regional Homogeneity (ReHo).
- Employed SVM analysis to build a classification model and assess diagnostic efficacy.
Main Results:
- MHE patients showed decreased ALFF in specific brain regions (AUC=0.75) and decreased ReHo (AUC=0.72).
- fALFF metrics demonstrated limited classification performance (AUC < 0.70).
- Decreased PerAF in specific frontal and parietal regions achieved high accuracy (AUC=0.83, accuracy=81.18%), outperforming other metrics.
Conclusions:
- Decreased mean PerAF in the right supramarginal gyrus, right dorsolateral superior frontal gyrus, and right middle frontal gyrus are potential neuroimaging indicators for MHE.
- These findings provide critical evidence for developing clinical screening protocols for early MHE identification.
- PerAF serves as a promising biomarker for early cognitive impairment detection in MHE patients.
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