PROTON MAGNETIC-RESONANCE SPECTROSCOPY OF THE BRAIN IN SYMPTOMATIC AND ASYMPTOMATIC PATIENTS WITH LIVER-CIRRHOSIS

Background & Aims: Hepatic encephalopathy (HE) is associated with typi cal changes of cerebral metabolite pattern observed by proton magnetic resonance (MR) spectroscopy consisting of a depletion of myo-inositol and an increase of glutamine. The aim of this study was to determine whether abnormalities in brain metabolism in neurologically asymptomat ic patients with liver cirrhosis can be detected by spectroscopy. Meth ods: In a prospective study, 39 patients with liver cirrhosis were exa mined clinically according to standardized neuropsychological tests to define whether overt, subclinical, or no hepatic encephalopathy was p resent. All patients underwent proton MR spectroscopy at short echo ti mes. Results: Spectroscopy allowed for the diagnosis of subclinical HE in 4 of 4 cases and of overt HE in 10 of 11 cases. In 24 cases of mer e liver cirrhosis and normal neuropsychological testing, a typical met abolic pattern with a depletion of myo-inositol and an increased gluta mine peak were found. A good correlation between the glutamine signal and the clinical grading was found. Conclusions: Proton MR spectroscop y allows for the diagnosis of HE and subclinical HE, also shows the ty pical pathological metabolite pattern in patients with cirrhotic liver s without subclinical HE, and might be more sensitive than neuropsycho logical testing. Glutamine could serve as a spectroscopic marker for t he clinical state of the patients.