Metabolic Brain Disease

, Volume 27, Issue 4, pp 551–557 | Cite as

Regional reduction in gray and white matter volume in brains of cirrhotic patients: voxel-based analysis of MRI

  • Motoh Iwasa
  • Rumi Mifuji-Moroka
  • Makoto Kuroda
  • Hideo Moroka
  • Naoki Fujita
  • Yoshinao Kobayashi
  • Yukihiko Adachi
  • Esteban C. Gabazza
  • Hiroshi Matsuda
  • Yoshiyuki Takei
Original Paper


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.


Liver cirrhosis Hepatic encephalopathy Ammonia MRI Voxel-based morphometry 



Magnetic resonance imaging


Voxel-based morphometry


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.


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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Motoh Iwasa
    • 1
  • Rumi Mifuji-Moroka
    • 1
    • 2
  • Makoto Kuroda
    • 3
  • Hideo Moroka
    • 4
  • Naoki Fujita
    • 1
  • Yoshinao Kobayashi
    • 1
  • Yukihiko Adachi
    • 2
  • Esteban C. Gabazza
    • 5
  • Hiroshi Matsuda
    • 6
  • Yoshiyuki Takei
    • 1
  1. 1.Department of Gastroenterology and HepatologyMie University Graduate School of MedicineTsuJapan
  2. 2.Department of Internal MedicineKuwana City HospitalKuwanaJapan
  3. 3.Department of GastroenterologyMatsusaka City HospitalMatsusakaJapan
  4. 4.Department of CardiologyMatsusaka City HospitalMatsusakaJapan
  5. 5.Department of ImmunologyMie University Graduate School of MedicineTsuJapan
  6. 6.Department of Nuclear MedicineSaitama Medical University International Medical CenterHidakaJapan

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