刘梅红;刘辉;张岚;黄婷婷;

• 1:驻马店市中心医院消化内科
• 2:驻马店市中心医院神经内科
• 3:河南中医药大学第一附属医院影像科

摘要(Abstract)：

目的通过磁共振扩散加权成像(DWI)和扩散张量成像(DTI)定量分析轻微型肝性脑病(MHE)患者脑功能的异常改变,探讨DWI和DTI在MHE中的应用价值。方法 30例肝硬化患者经神经心理测试评分量表测试后,分为MHE组16例和无MHE单纯肝硬化组14例,同时选取15例健康志愿者为正常对照组。所有受试者均行DWI与DTI扫描,选取脑内8个部位为感兴趣区,计算各部位的表观扩散系数(ADC)值和各向异性分数(FA)值。结果 18例肝硬化患者于T_1WI图像上可见到双侧内囊、苍白球对称性高信号。额叶、枕叶白质、胼胝体膝部、胼胝体压部、内囊前肢、内囊后肢、尾状核头部由正常组、单纯肝硬化组至MHE组ADC值逐渐增加,且MHE组的ADC值较肝硬化组和正常组增加,差异有统计学意义(P<0.05);胼胝体膝部和压部的FA值由正常组、单纯肝硬化组至MHE组逐渐降低,差异有统计学意义(P<0.05)。结论 DWI与DTI联合应用能够预测肝硬化患者MHE的进展程度,具有潜在的临床价值。

关键词(KeyWords)： 肝硬化;肝性脑病;磁共振成像;扩散加权成像;扩散张量成像

Abstract:

Keywords:

基金项目(Foundation): 河南省科技厅科技攻关项目(编号:182102310294)

作者(Authors): 刘梅红;刘辉;张岚;黄婷婷;

参考文献(References)：

• [1] AMODIO P.Hepatic encephalopathy:Diagnosis and management[J].Liver Int,2018,38(6):966-975.DOI:10.1111/liv.13752.
• [2] 王结实.门-体分流术后并发肝性脑病的危险因素分析[J].中国实用神经疾病杂志,2017,20(19):105-107.
• [3] 王建伟,刘素梅,杨宵曼,等.乙型肝炎肝衰竭患者发生肝性脑病的危险因素分析[J].中国实用神经疾病杂志,2017,20(2):69-70.
• [4] STEWART C A,SMITH G E.Minimal hepatic encephalopathy[J].Nat Clin Pract Gastroenterol Hepatol,2007,4(12):677-685.DOI:10.1038/ncpgasthep0999.
• [5] STEWART C A,AUGER R R,ENDERS F T,et al.The effects of poor sleep quality on cognitive function of patients with cirrhosis[J].J Clin Sleep Med,2014,10(1):21-26.DOI:10.5664/jcsm.3350.
• [6] FELIPO V,URIOS A,VALERO P,et al.Serum nitrotyrosine and psychometric tests as indicators of impaired fitness to drive in cirrhoticpatients with minimal hepatic encephalopathy[J].Liver Int,2013,33(10):1478-1489.DOI:10.1111/liv.12206.
• [7] RIDOLA L,NARDELLI S,GIOIA S,et al.Quality of life in patientswith minimal hepatic encephalopathy[J].World J Gastroenterol,2018,24(48):5446-5453.DOI:10.3748/wjg.v24.i48.5446.
• [8] FLUD C R,DUARTE-ROJO A.Prognostic Implications of Minimal/Covert Hepatic Encephalopathy:Large-scale Validation Cohort Studies[J].J Clin Exp Hepatol,2019,9(1):112-116.DOI:10.1016/j.jceh.2018.04.009.
• [9] NARDONE R,TAYLOR A C,H?LLER Y,et al.Minimal hepatic encephalopathy:A review[J].Neurosci Res,2016,111:1-12.DOI:10.1016/j.neures.2016.04.009.
• [10] ELLIOTT C A,DANYLUK H,ARONYK K E,et al.Intraoperative acquisition of DTI in cranial neurosurgery:readout-segmented DTI versus standard single-shot DTI[J].J Neurosurg,2019,16:1-10.DOI:10.3171/2019.5.JNS19890.
• [11] KIM B,FISHER B E,SCHWEIGHOFER N,et al.A comparison of seven different DTI-derived estimates of corticospinal tract structural characteristics in chronic stroke survivors[J].J Neurosci Methods,2018,304:66-75.DOI:10.1016/j.jneumeth.2018.04.010.
• [12] LACEY C,OHLHAUSER L,GAWRYLUK J R,et al.Microstructural White Matter Characteristics in Parkinson's Disease With Depression:A Diffusion Tensor Imaging Replication Study[J].Front Neurol,2019,10:884.DOI:10.3389/fneur.2019.00884.
• [13] FERENCI P,LOCKWOOD A,MULLEN K,et al.Hepatic encephalopathy--definition,nomenclature,diagnosis,and quantification:final rep ort of the working party at the 11th World Congresses of Gastroenterology,Vienna,1998[J].Hepatology,2002,35(3):716-721.DOI:10.1053/jhep.2002.31250.
• [14] NARDELLI S,GIOIA S,FACCIOLI J,et al.Sar-copenia and cognitive impairment in liver cirrhosis:A viewpoint on the clinical impact of minimal hepatic encephalopathy[J].World J Gastroenterol,2019,25(35):5257-5265.DOI:10.3748/wjg.v25.i35.5257.
• [15] GUO R M,LI Q L,ZHONG L R,et al.Brain MRI findings in acute hepatic encephalopathy in liver transplant recipients[J].Acta Neurol Belg,2018,118(2):251-258.DOI:10.1007/s13760-017-0875-7.
• [16] KRONLAGE M,SCHWEHR V,SCHWARZ D,et al.Peripheral nerve diffusion tensor imaging (DTI):normal values and demographic determinants in a cohort of 60 healthy individuals[J].Eur Radiol,2018,28(5):1801-1808.DOI:10.1007/s00330-017-5134-z.
• [17] KARAMAN I,GUNAY A E,YETKIN M F,et al.Diffusion tensor imaging of the median nerve healing.Preliminary results[J].Ann Ital Chir,2019;90:264-268.
• [18] MOLE J P,SUBRAMANIAN L,BRACHT T,et al.Increased fractional anisotropy in the motor tracts of Parkinson's disease suggests compensatory neuroplasticity or selective neurodegeneration[J].Eur Radiol,2016,26(10):3327-3335.DOI:10.1007/s00330-015-4178-1.
• [19] SATO T,ENDO K,KAKISAKA K,et al.Decreased Mean Kurtosis in the Putamen is a Diagnostic Feature of Minimal Hepatic Encephalopathy in Patients with Cirrhosis[J].Intern Med,2019,58(9):1217-1224.DOI:10.2169/internalmedicine.2116-18.
• [20] LI J L,JIANG H,ZHANG X D,et al.Microstructural brain abnormalities correlate with neurocognitive dysfunction in minimal hepatic encephalopathy:a diffusion kurtosis imaging study[J].Neuroradiology,2019,61(6):685-694.DOI:10.1007/s00234-019-02201-4.
• [21] CUDALBU C,TAYLOR-ROBINSON S D.Brain Edema in Chronic Hepatic Encephalopathy[J].J Clin Exp Hepatol,2019,9(3):362-382.DOI:10.1016/j.jceh.2019.02.003.
• [22] CHEN H J,CHEN R,YANG M,et al.Identification of minimal hepatic encephalopathy in patients with cirrhosis based on white matter imaging and Bayesian data mining[J].AJNR Am J Neuroradiol,2015,36(3):481-487.DOI:10.3174/ajnr.A4146.
• [23] QI R,XU Q,ZHANG L J,et al.Structural and functional abnormalities of default mode network in minimal hepatic encephalopathy:a study combining DTI and fMRI[J].PLoS One,2012,7(7):e41376.DOI:10.1371/journal.pone.0041376.
• [24] RUDLER M,WEISS N,PERLBARG V,et al.Combined diffusion tensor imaging and magnetic resonance spectroscopy to predict neurological outcome before transjugular intrahepatic portosystemic shunt[J].Aliment Pharmacol Ther,2018,48(8):863-874.DOI:10.1111/apt.14938.
• [25] 彭君,刘鹏飞.轻微型肝性脑病的DTI定量研究[J].放射学实践,2009,24(9):986-989.
• [26] GROVER V P,CROSSEY M M,FITZPATRICK J A,et al.Quantitative magnetic resonance imaging in patients with cirrhosis:a cross-sectional study[J].Metab Brain Dis,2016,31(6):1315-1325.DOI:10.1007/s11011-015-9716-7.