Regional reduction in gray and white matter volume in brains of cirrhotic patients: voxel-based analysis of MRI
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Chronic hepatic encephalopathy is a characteristically reversible neuropsychiatric disorder that occurs mainly in patients with liver cirrhosis. The brain regions critically involved in the pathophysiology of cirrhosis are not clear. Magnetic resonance imaging (MRI) with voxel-based morphometry (VBM) is a valuable tool for evaluating structural brain changes in many neurodegenerative diseases. We performed an MRI scan on 18 patients with liver cirrhosis and 16 age-matched healthy controls. We evaluated brain regional structural changes, regional differences and the relationship of these changes with the blood levels of ammonia and the results of neuropsychological tests in patients with cirrhosis. The VBM showed reduction in the volume of gray matter in the cerebellum and occipital lobe and in the volume of white matter in the cingulate, parietal, temporal, occipital lobe and precentral area in cirrhotic patients compared with controls. There were significant correlations between the volume of these regions with the plasma levels of ammonia and the results of neuropsychological tests. Voxel-based analysis of MRI revealed evidence for structural abnormalities of brain in patients with cirrhosis. Abnormal function in the above regions may account for the ammonia-mediated changes and neuropsychological deficits in hepatic encephalopathy.
KeywordsLiver cirrhosis Hepatic encephalopathy Ammonia MRI Voxel-based morphometry
Magnetic resonance imaging
Statistical parametric mapping
Diffeomorphic anatomical registration through an exponentiated Lie algebra
We are grateful to Keiko Takayama (Kuwana City Hospital) for her excellent technical support.
The authors declare that no conflict of interest exists concerning this paper.
- Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT (2002) Hepatic encephalopathy–definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology 35:716–721PubMedCrossRefGoogle Scholar
- Guevara M, Baccaro ME, Gómez-Ansón B, Frisoni G, Testa C, Torre A, Molinuevo JL, Rami L, Pereira G, Sotil EU, Córdoba J, Arroyo V, Ginès P (2011) Cerebral magnetic resonance imaging reveals marked abnormalities of brain tissue density in patients with cirrhosis without overt hepatic encephalopathy. J Hepatol 55:564–573PubMedCrossRefGoogle Scholar
- Kato A, Kato M, Ishii H, Ichimiya Y, Suzuki K, Kawasaki H, Yamamoto SI, Kumashiro R, Yamamoto K, Kawamura N, Hayashi N, Matsuzaki S, Terano A, Okita K, Watanabe A (2004) Development of quantitative neuropsychological tests for diagnosis of subclinical hepatic encephalopathy in liver cirrhosis patients and establishment of diagnostic criteria-multicenter collaborative study in Japanese. Hepatol Res 30:71–78PubMedCrossRefGoogle Scholar
- Nguyen JH, Yamamoto S, Steers J, Sevlever D, Lin W, Shimojima N, Castanedes-Casey M, Genco P, Golde T, Richelson E, Dickson D, McKinney M, Eckman CB (2006) Matrix metalloproteinase-9 contributes to brain extravasation and edema in fulminant hepatic failure mice. J Hepatol 44:1105–1114PubMedCrossRefGoogle Scholar
- Skowrońska M, Zielińska M, Wójcik-Stanaszek L, Ruszkiewicz J, Milatovic D, Aschner M, Albrecht J (2012) Ammonia increases paracellular permeability of rat brain endothelial cells by a mechanism encompassing oxidative/nitrosative stress and activation of matrix metalloproteinases. J Neurochem 121:125–134PubMedCrossRefGoogle Scholar
- Takahashi R, Ishii K, Miyamoto N, Yoshikawa T, Shimada K, Ohkawa S, Kakigi T, Yokoyama K (2010) Measurement of gray and white matter atrophy in dementia with Lewy bodies using diffeomorphic anatomic registration through exponentiated lie algebra: a comparison with conventional voxel-based morphometry. Am J Neuroradiol 31:1873–1878PubMedCrossRefGoogle Scholar
- Yamasue H, Kasai K, Iwanami A, Ohtani T, Yamada H, Abe O, Kuroki N, Fukuda R, Tochigi M, Furukawa S, Sadamatsu M, Sasaki T, Aoki S, Ohtomo K, Asukai N, Kato N (2003) Voxel-based analysis of MRI reveals anterior cingulate gray-matter volume reduction in posttraumatic stress disorder due to terrorism. Proc Natl Acad Sci U S A 100:9039–9043PubMedCrossRefGoogle Scholar