The Study Of RS-fMRI And ~1H-MRS In Patients With Covert Hepatic Encephalopathy

Objective:1. Using Resting-State functional MRI(RS-fMRI) and amplitude of low frequency fluctuation(ALFF), we explored the spontaneous brain activity changes in cirrhosis patients with covert hepatic encephalopathy(CHE).2. Applying proton magnetic resonance spectroscopy (1H-MRS), we examined the brain metabolites changes in cirrhosis patients with covert hepatic encephalopathy.3. Combined two methods to study the pattern of the posterior cingulated gyrus in the performance of fMRI and MRS with CHE.Methods:By cirrhosis of clinical diagnostic criteria, exclusion criteria and hepatic encephal opathy psychological test scores,17 cirrhosis patients with covert hepatic encephalopat hy were included in the study.10 males and 7 females, the average age of 46.76 ± 10.06 years (28-67 years old), educational attainment 12.29 ± 2.02 years (9-16 years). Meanwhile included 17 cases with their sex, age and level of education-matched heal thy volunteers as a control group.9 males and 8 females, the average age of 42.47 ± 9.55 years (25-65 years old), educational attainment 13.76 ± 1.82 years (11-16 years). By the Siemens Trio Tim 3.0T superconductive MR scanner to scan the whole brai n’s resting state and the single voxel resolution spin-echo spectroscopy inspection on posterior cingulate gyrus. DPARS and Rest software based on Matlab was employed t o collect,analyse and find the statistics difference brain areas. Select the posterior cin gulate as the interested region, The data of MRS was processed by Siemens workstati on to analysis, calculate N-acetyl aspartate(N-acetyl aspartate, NAA), creatine (creatinin e, Cr), choline(choline, Cho), myo-inositol (myo-inositol, ml), glutamine compound (G1 utamine, Glx) and creatine (Cr) ratio. Applicated SPSS 18.0 and compared between the two groups NAA/Cr, Cho/Cr, mI/Cr, Glx/Cr in the presence or absence of significant difference. Finally, correlation analysis of each metabolite and NCT-A and DST of e xperiments were performed.Results:1. Compared with normal control group, the ALFF value of patients with covert thepatic encephalopathy lower brain areas include:bilateral parahippocampal gyrus, bilateral anterior lobe wedge, the left middle temporal gyrus, the left middle frontal gyrus, the left occipital gyrus, left precentral gyrus, left posterior cingulate gyrus, right inferior parietal lobule, right inferior frontal gyrus, right superior frontal gyrus, the difference was statistically significant (P<0.05). Also showed significantly ALFF increased in bilateral middle temporal gyrus, the right hemisphere of the cerebellum posterior lobe, the right fusiform gyrus, right superior frontal gyrus, right medial frontal gyrus, left cerebellar hemisphere anterior lobe, left anterior cingulate gyrus. These differences had statistics significance (P<0.05)2.Compared with healthy controls, the patients with covert thepatic encephalopathy showed decreased ml/Cr, Cho/Cr and increased Glx/Cr in posterior cingulate gyrus. These differences had statistics significance (P<0.05)3. Do correlation that each metabolite ratios and NCT-A and DST test found that the Cho/Cr and mI/Cr of the patients with covert thepatic encephalopathy on posterior cingulated gyrus with NCT-A showed the negative correlation.Conclusion:1. There are abnormal spontaneous neuron activity in multiple brain regions of patients with covert thepatic encephalopathy.2.There are abnormal metabolites difference in posterior cingulate gyrus of patients with covert hepatic encephalopathy.1H-MRS technology can be used for the screening of early covert hepatic encephalopathy and the preliminary diagnosis.3.Research by combining the two methods, the posterior cingulated gyrus of the patients with covert hepatic encephalopathy on RS-fMRI showed decreased brain activity. On MRS showed Cho and ml peak decreased, Glx peak increased, and the part of metabolites with NCT-A showed the negative correlation. So it may indicate the presence of covert hepatic encephalopathy.