SUBCLINICAL HEPATIC-ENCEPHALOPATHY - PROTON MR SPECTROSCOPIC ABNORMALITIES

PURPOSE: To determine whether hydrogen-1 magnetic resonance (MR) spect roscopy of the brain allows detection of subclinical hepatic encephalo pathy (SCHE). MATERIALS AND METHODS: In a double-blind study, overt he patic encephalopathy (HE) and SCHE (defined with clinical and neuropsy chiatric tests) were compared by means of H-1 MR spectroscopic criteri a-reduction in cerebral myo-inositol (<2 standard deviations [SDs] fro m normal) and choline (<2 SDs from normal) with or without increased c erebral glutamine (>1 SD from normal)-in 20 patients with cirrhosis. R ESULTS: Concordance between MR spectroscopic and neuropsychiatric test results was 94% (kappa = 0.84). MR spectroscopy allowed diagnosis of SCHE in nine of nine patients (100%) and of HE in seven of eight (88%) . Myo-inositol depletion alone had 80%-85% sensitivity for detection o f HE and SCHE. CONCLUSION: H-1 MR spectroscopy allows accurate diagnos is of SCHE, and the results suggest an important role for myo-inositol in psychomotor and visuopractic functions.