CEREBRAL ABNORMALITIES IN PATIENTS WITH CIRRHOSIS DETECTED BY PROTON MAGNETIC-RESONANCE SPECTROSCOPY AND MAGNETIC-RESONANCE-IMAGING

Hepatic encephalopathy is a common problem in cirrhosis. The pathogene sis of this complication of advanced liver disease still remains uncle ar, Magnetic resonance spectroscopy was used to assess prospectively c erebral metabolism in 51 patients with histologically proven cirrhosis (Child-Pugh classes A, B, and C, 18, 18, and 15, respectively) and 36 healthy volunteers, According to the results of psychometric tests, o vert hepatic encephalopathy, subclinical encephalopathy, and no enceph alopathy were found in 14, 21, and 16 patients, respectively, Myoinosi tol/creatine ratios in gray (.36 +/- .17) and white (.35 +/- .22) matt er voxel were reduced significantly (P < .0001) in cirrhotic patients compared with healthy volunteers (gray matter, .51 +/- .11; white matt er, .64 +/- .16). in addition, patients showed a significant reduction (P = .024) in white matter choline/creatine ratio (.77 +/- .27) compa red with controls (.92 +/- .25), and glutamine/glutamate level was ele vated in cirrhotic patients compared with controls (gray matter, P < . 0001; white matter, P = .036). Changes in cerebral myoinositol and glu tamine/glutamate levels correlated significantly with the severity of hepatic encephalopathy (P < .0001), However, these metabolic alteratio ns were also detected in patients without hepatic encephalopathy (norm al psychometric test results), N-acetyl aspartate/creatine ratios did not differ between patients and controls, Magnetic resonance imaging d etected bright basal ganglia in 37 patients, which correlated signific antly with portal-systemic shunting and elevation of glutamine/glutama te, but not with the degree of hepatic encephalopathy, Ln conclusion, magnetic resonance imaging and spectroscopy showed that alterations of cerebral metabolism are common in patients with cirrhosis, even witho ut evidence of clinical or subclinical hepatic encephalopathy.