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Quantitative magnetic resonance imaging in patients with cirrhosis: a cross-sectional study

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Abstract

Cerebral magnetic resonance imaging was undertaken, at 3 Tesla field strength, employing magnetization transfer (MT) and diffusion-weighted imaging (DWI) sequences, in 26 patients with well-compensated cirrhosis, free of overt hepatic encephalopathy. Results were compared to those from 18 aged-matched healthy volunteers. Cerebral magnetization transfer ratios (MTR) were reduced in the frontal white matter, caudate, putamen and globus pallidus in patients with cirrhosis, compared to healthy controls, while the apparent diffusion coefficients (ADC) on DWI were significantly increased in the genu and body of the corpus callosum. An association between previous excessive alcohol consumption and both MTR and ADCs was noted, but this association was lost when controls were exercised for the severity of liver disease and psychometric impairment on multivariate analysis. Eight (31 %) of the 26 patients had impaired psychometric performance consistent with a diagnosis of minimal hepatic encephalopathy. No statistically significant difference in regional cerebral MTRs or ADCs was found in relation to neuropsychiatric status, although there was a trend towards lower MTRs in patients with impaired psychometric performance. The alterations in MTR and ADC in the patients with functionally compensated cirrhosis are compatible with theories governing the genesis of hepatic encephalopathy, including changes in astrocyte membrane permeability, with subsequent redistribution of macromolecules.

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Acknowledgments

All authors acknowledge the support of the National Institute for Health Research Biomedical Research Centre at Imperial College London for infrastructure support. VPBG was supported by grants from the Royal College of Physicians of London, the University of London and the Trustees of St Mary’s Hospital, Paddington. MMEC is supported by a Fellowship from the Sir Halley Stewart Trust (Cambridge, United Kingdom). MMEC and SDT-R hold grants from the United Kingdom Medical Research Council, which provided running costs and some infrastructure support for the study.

Disclosures

BKS is a former employee of Cognitive Drug Research Ltd., the developer of the CDR battery used in this study. The CDR battery is now owned by Bracket (Wayne, PA, USA), a company that provides clinical trial services to the pharmaceutical industry. The CDR battery was provided for use in this study free of charge.

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Authors and Affiliations

  1. Liver Unit, Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Imperial College London, 10th Floor QEQM Wing, St. Mary’s Hospital Campus, South Wharf Street, London, W2 1NY, UK

    Vijay P. B. Grover, Mary M. E. Crossey, Julie A. Fitzpatrick, Roberta Shaw & Simon D. Taylor-Robinson

  2. Robert Steiner MRI Unit, Imaging Sciences Department, MRC Clinical Sciences Centre, Imperial College London, London, UK

    Vijay P. B. Grover, Julie A. Fitzpatrick & Adam D. Waldman

  3. Centre for Ageing and Health, Newcastle University, Newcastle-upon-Tyne, UK

    Brian K. Saxby

  4. UCL Institute for Liver & Digestive Health, Division of Medicine, University College London, Royal Free Campus, London, UK

    Marsha Y. Morgan

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  1. Vijay P. B. Grover
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Grover, V.P.B., Crossey, M.M.E., Fitzpatrick, J.A. et al. Quantitative magnetic resonance imaging in patients with cirrhosis: a cross-sectional study. Metab Brain Dis 31, 1315–1325 (2016). https://doi.org/10.1007/s11011-015-9716-7

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