1. A longitudinal study of patients with cirrhosis treated with L-ornithine L-aspartate, examined with magnetization transfer, diffusion-weighted imaging and magnetic resonance spectroscopy
- Author
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Simon D. Taylor-Robinson, Brian K. Saxby, L. Southern, I. Jane Cox, Vijay P. B. Grover, Nicola A Cook, Julie Fitzpatrick, Mary M.E. Crossey, Aluel Bak-Bol, Adam D. Waldman, Roger Williams, Mark J. W. McPhail, Novraj S. Dhanjal, Marsha Y. Morgan, Marzena Wylezinska-Arridge, Imperial College Trust, Friends of Hammersmith Hospital, Medical Research Council (MRC), National Institutes of Health, and Imperial College Healthcare NHS Trust- BRC Funding
- Subjects
In vivo magnetic resonance spectroscopy ,Liver Cirrhosis ,Male ,Pathology ,Cirrhosis ,Magnetic Resonance Spectroscopy ,MR SPECTROSCOPY ,PROTON ,Biochemistry ,CHRONIC LIVER-DISEASE ,BASAL GANGLIA ,0302 clinical medicine ,Nuclear magnetic resonance ,Cognition ,Hepatic encephalopathy ,Spectroscopy ,medicine.diagnostic_test ,Brain ,Dipeptides ,Middle Aged ,Magnetic Resonance Imaging ,medicine.anatomical_structure ,030211 gastroenterology & hepatology ,Original Article ,Female ,COEFFICIENT ,Life Sciences & Biomedicine ,WHITE-MATTER ,Adult ,medicine.medical_specialty ,Psychometrics ,Clinical Neurology ,CONTRAST MEASUREMENTS ,White matter ,Endocrinology & Metabolism ,03 medical and health sciences ,Cellular and Molecular Neuroscience ,GRADE CEREBRAL EDEMA ,Fractional anisotropy ,medicine ,MINIMAL HEPATIC-ENCEPHALOPATHY ,Humans ,Magnetization transfer ,Aged ,Science & Technology ,Neurology & Neurosurgery ,business.industry ,Neurosciences ,1103 Clinical Sciences ,Magnetic resonance imaging ,equipment and supplies ,medicine.disease ,Diffusion Magnetic Resonance Imaging ,Hepatic Encephalopathy ,Neurosciences & Neurology ,Neurology (clinical) ,1109 Neurosciences ,business ,human activities ,030217 neurology & neurosurgery ,Diffusion MRI - Abstract
The presence of overt hepatic encephalopathy (HE) is associated with structural, metabolic and functional changes in the brain discernible by use of a variety of magnetic resonance (MR) techniques. The changes in patients with minimal HE are less well documented. Twenty-two patients with well-compensated cirrhosis, seven of whom had minimal HE, were examined with cerebral 3 Tesla MR techniques, including T1- and T2-weighted, magnetization transfer and diffusion-weighted imaging and proton magnetic resonance spectroscopy sequences. Studies were repeated after a 4-week course of oral L-ornithine L-aspartate (LOLA). Results were compared with data obtained from 22 aged-matched healthy controls. There was no difference in mean total brain volume between patients and controls at baseline. Mean cerebral magnetization transfer ratios were significantly reduced in the globus pallidus and thalamus in the patients with cirrhosis irrespective of neuropsychiatric status; the mean ratio was significantly reduced in the frontal white matter in patients with minimal HE compared with healthy controls but not when compared with their unimpaired counterparts. There were no significant differences in either the median apparent diffusion coefficients or the mean fractional anisotropy, calculated from the diffusion-weighted imaging, or in the mean basal ganglia metabolite ratios between patients and controls. Psychometric performance improved in 50 % of patients with minimal HE following LOLA, but no significant changes were observed in brain volumes, cerebral magnetization transfer ratios, the diffusion weighted imaging variables or the cerebral metabolite ratios. MR variables, as applied in this study, do not identify patients with minimal HE, nor do they reflect changes in psychometric performance following LOLA. Electronic supplementary material The online version of this article (doi:10.1007/s11011-016-9881-3) contains supplementary material, which is available to authorized users.
- Published
- 2016
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