Transjugular intrahepatic portosystemic shunt induced short- and long-term cerebral blood flow variations in cirrhotic patients: an arterial spin labeling MRI study
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Short- and long-term effects of transjugular intrahepatic portosystemic shunt (TIPS) on cerebral blood flow (CBF) in patients with cirrhosis are still unclear. The purpose of this longitudinal study was to explore CBF alteration patterns in cirrhotic patients after TIPS. Thirteen cirrhotic patients (7 male, 6 female, mean age 50.0 ± 9.3 years) underwent arterial-spin labeling (ASL) MRI 1–9 days (median 1 days) before TIPS. Follow-up MR examinations were performed about 1 week (median 6 days), 3 months (n = 6), 6–9 months (n = 5) and 12–18 months (n = 5) after TIPS. CBF, ammonia level, Child-Pugh score, number connection test type A (NCT-A) and digit symbol test (DST) scores were converted into relative values by dividing by his/her pre-TIPS values, and then, compared via one-way analysis of variance (ANOVA). Correlations between the pre- and post-TIPS changes of relative CBF (rCBF) and the changes of relative ammonia (rAmmonia), Child-Pugh (rChild-Pugh), and NCT-A/DST (rNCT-A/rDST) scores were calculated by crossing subjects. Compared with the pre-TIPS level, the global rCBF slightly increased by 10.9 % about 1 week later, then rapidly decreased by 14.2 % 3 months later, and flatly decreased by 17.2 % in 6–9 months and 18.0 % in 12–18 months following TIPS. The changes of 3-month rDST score were slightly correlated with 3-month rCBF rather than 1-week rCBF, (P < 0.1, FDR-corrected) No difference was found between the pre- and post-TIPS rAmmonia levels, rChild-Pugh and rNCT-A/rDST scores (Post-hoc P > 0.05). CBF measured at different time points after TIPS insertion showed different patterns, indicating varying longitudinal effects of TIPS on CBF. A sharp decline of rCBF was found in the 1 week to 3 months period after insertion, indicating that high event rate of hepatic encephalopathy might relate with the unadaptable CBF in patients undergoing TIPS insertion.
KeywordsTransjugular intrahepatic portosystemic shunt Short and long-term effects, arteril spin labeling Cerebral blood flow Hepatic encephalopathy
Transjugular intrahepatic portosystemic shunt
Arterial spin labeling
Number-connection test type A
Digit symbol test
Cerebral blood flow
Overt hepatic encephalopathy
Gang Zheng and Long Jiang Zhang participated to an equal extent in planning, analyzing, evaluating, and writing the paper.
Yue Cao contributed to critical revision of the manuscript.
Rong Feng Qi, Ling Ni and Donghong Shi contributed to acquisition of data.
Zhiying Pan contributed to statistical analysis.
Guang Ming Lu, Donghong Shi and Xinxin Fan contributed to transjugular intrahepatic portosystemic shunt procedures for cirrhotic patients.
Long Jiang Zhang and Guang Ming Lu contributed to study concept and supervision.
Conflicts of interest
The authors disclose no conflicts.
Supported by grants from National Natural Science Foundation of China (grant No. 81101039 to G.Z., grants No. 30700194, 81171313 and 81230032 to L.J.Z.) and China Postdoctoral Science Foundation of Jiangsu Province (grant No. 1002083C to G.Z.).
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