Proton magnetic resonance spectroscopy (H-1-MRS) findings for the brain inpatients with liver cirrhosis reflect the hepatic functional reserve

OBJECTIVE: Proton magnetic resonance spectroscopy (H-1-MRS) has been used t o assess the metabolic changes in the brain in patients with liver cirrhosi s. Decreased myo-inositol and increased glutamine levels were noted to be t he most sensitive spectroscopic markers for cirrhotic patients with hepatic encephalopathy (HE). The purpose of this study was to assess how the abnor malities seen on the H-1-MRS of the brain in patients with liver cirrhosis are related to clinical and laboratory parameters. METHODS: In a prospective study, localized H-1-MRS was performed in the bas al ganglia and parietal white matter regions in liver cirrhosis patients wi th (n = 48) and without (n = 52) HE and chronic hepatitis (CH) (n = 15), an d in normal controls (n = 20). RESULTS: Among cirrhotic patients, the myo-inositol levels were significant ly lower (p < 0.01) and the glutamine levels were higher (p < 0.05) for pat ients with HE than for those without HE. The myo-inositol and glutamine lev els, respectively, were inversely (r = -0.50; p < 0.001) and linearly (r = 0.50; p < 0.001) related to the Child-Pugh score. However, by subgroup anal ysis of Child-Pugh class C patients, there were no significant differences in the myoinositol and glutamine levels between cirrhotic patients with (n = 40) and without HE (n = 24). A follow-up study of eight cirrhotic patient s with HE showed no significant differences in the myo-inositol and glutami ne levels after clinical improvement of HE. CONCLUSIONS: The abnormalities seen on the H-1-MRS of the brain of patients with liver cirrhosis are not Likely to reflect the severity of HE or acute alteration in the level of consciousness. Rather, we believe they represen t the chronic metabolic derangement of the brain associated with hepatic fu nctional reserve. (Am J Gastroenterol 1999;94:2206-2213. (C) 1999 by Am. Ce ll. of Gastroenterology).