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non invasive blood flow measurement in cerebellum detects minimal hepatic encephalopathy earlier than psychometric tests

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World Journal of Gastroenterology 2014年第33期20卷 11815-11825页

作者： Vicente Felipo Amparo Urios Carla Giménez-Garzó Omar Cauli Maria-Jesús Andrés-Costa Olga González Miguel A Serra Javier Sánchez-González Roberto Aliaga remedios giner-durán Vicente Belloch Carmina Montoliu Laboratory of neurobiology Centro Investigación Príncipe Felipe 46012Valencia Spain Fundación Investigación Hospital Clínico de Valencia. Instituto de Investigación Sanitaria INCLIVA 46010 Valencia Spain Servicio DigestivoHospital Arnau de Vilanova 46015 Valencia Spain Grupo Hepatología Servicio Aparato Digestivo Hospital Clínico de Valencia 46010 Valencia Spain Philips Healthcare Iberia 28050 Madrid Spain ERESA Unidad RM 46015 Valencia Spain Departamento de Patología Facultad de Medicina Universidad de Valencia 46010 Valencia Spain

AIM: To assess whether non invasive blood flow measurement by arterial spin labeling in several brain regions detects minimal hepatic encephalopathy. METHODS: Blood flow(BF) was analyzed by arterial spin labeling(ASL) in different brain areas of 14 controls, 24 cirrhotic patients without and 16 cirrhotic patients with minimal hepatic encephalopathy(MHE). Images were collected using a 3 Tesla MR scanner(Achieva 3T-TX, Philips, netherlands). Pulsed ASL was performed. Patients showing MHE were detected using the battery Psychometric Hepatic Encephalopathy Score(PHES) consisting of five tests. Different cognitive and motor functions were also assessed: alterations in selective attention were evaluated using the Stroop test. Patients and controls also performed visuo-motor and bimanual coordination tests. Several biochemical parameters were measured: serum pro-inflammatory interleukins(IL-6 and IL-18), 3-nitrotyrosine, cGMP and nitrates+nitrites in plasma, and blood ammonia. Bivariate correlations were evaluated.RESULTS: In patients with MHE, BF was increased in cerebellar hemisphere(P = 0.03) and vermis(P = 0.012) and reduced in occipital lobe(P = 0.017). BF in cerebellar hemisphere was also increased in patients without MHE(P = 0.02). Bimanual coordination was impaired in patients without MHE(P = 0.05) and much more in patients with MHE(P nation was impaired only in patients with MHE(P ntion was slightly affected in patients without MHE and more strongly in patients with MHE(Pn cerebellar hemisphere and vermis correlated with performance in most tests of PHES [(number connection tests A(nCT-A), B(nCT-B)and line tracing test] and in the congruent task of Stroop test. BF in frontal lobe correlated with nCT-A. Performance in bimanual and visuomotor coordination tests correlated only with BF in cerebellar hemisphere. BF in occipital lobe correlates with performance in the PHES battery and with CFF. BF in cerebellar hemisphere correlates with plasma cGMP and nitr

关键词： Arterial spin labelling neurological impair-ment B

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