Authors: Sugimoto, Ryosuke¹; Iwasa, Motoh¹; Maeda, Masayuki²; Urawa, Naohito¹; Tanaka, Hideaki¹; Fujita, Naoki¹; Kobayashi, Yoshinao¹; Takeda, Kan²; Kaito, Masahiko¹; Takei, Yoshiyuki¹

Source: The American Journal of Gastroenterology, Volume 103, Number 6, June 2008 , pp. 1413-1420(8)

Publisher: Wiley-Blackwell

Abstract:

BACKGROUND AND AIMS: Minimal hepatic encephalopathy (HE) is associated with poorer quality of life and increased work disability. Recently, low-grade cerebral edema has been implicated in chronic liver disease.

METHODS: We measured the apparent diffusion coefficient (ADC) of water in various regions of the brains of patients with cirrhosis, and elucidated the significance of the evaluation of ADC in quantifying low-grade HE and predicting overt HE and survival. Forty patients with cirrhosis and 24 controls underwent diffusion-weighted imaging, and patients were followed up every month.

RESULTS: The mean ADC values were increased in cirrhotic patients with minimal HE versus no HE or controls. Minimal HE patients separated from no HE patients with a sensitivity of 70∼90% and a specificity of 85∼90%. ADC values correlated with individual neuropsychological tests. ADC values of white matter, such as the frontal (log-rank test 4.35, P < 0.05) and parietal (log-rank test 5.98, P < 0.05) white matter, was predictive of further bouts of overt HE.

CONCLUSIONS: ADC is a reliable tool for quantification of low-grade HE, and could predict the development of overt HE.

(Am J Gastroenterol 2008;103:1413-1420)

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1572-0241.2008.01788.x

Affiliations: 1: Department of Gastroenterology and Hepatology, Division of Clinical Medicine and Biomedical Sciences, Institute of Medical Science, Mie University Graduate School of Medicine, Tsu, Japan 2: Department of Radiology, Mie University School of Medicine, Tsu, Japan

Publication date: 2008-06-01

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