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Subclinical hepatic encephalopathy: proton MR spectroscopic abnormalities
B D Ross1, S Jacobson, F Villamil
1Magnetic Resonance Unit, Huntington Medical Research Institutes, Pasadena, CA 91105.
Radiology
|November 1, 1994
Summary
Hydrogen-1 MR spectroscopy accurately detects subclinical hepatic encephalopathy (SCHE) in cirrhosis patients. This brain imaging technique shows high concordance with clinical tests, highlighting myo-inositol
Area of Science:
- Neuroimaging
- Biochemistry
- Hepatology
Background:
- Subclinical hepatic encephalopathy (SCHE) presents diagnostic challenges.
- Early detection of SCHE is crucial for managing liver disease complications.
Purpose of the Study:
- To evaluate the efficacy of hydrogen-1 magnetic resonance (MR) spectroscopy in detecting SCHE.
- To compare MR spectroscopic findings with clinical and neuropsychiatric assessments.
Main Methods:
- A double-blind study involving 20 cirrhosis patients.
- H-1 MR spectroscopy assessed cerebral myo-inositol, choline, and glutamine levels.
- Spectroscopic criteria compared against established clinical and neuropsychiatric tests for overt hepatic encephalopathy (HE) and SCHE.
Main Results:
- MR spectroscopy demonstrated 94% concordance (kappa = 0.84) with neuropsychiatric tests.
- 100% accuracy in diagnosing SCHE (9/9 patients) and 88% accuracy for overt HE (7/8 patients).
- Myo-inositol depletion alone showed 80%-85% sensitivity for detecting HE and SCHE.
Conclusions:
- H-1 MR spectroscopy provides accurate diagnosis of SCHE.
- Findings suggest a significant role of myo-inositol in psychomotor and visuopractic functions.
- MR spectroscopy is a valuable tool for identifying SCHE in cirrhosis.