Decreased Mean Kurtosis in the Putamen is a Diagnostic Feature of Minimal Hepatic Encephalopathy in Patients with Cirrhosis
Decreased Mean Kurtosis in the Putamen is a Diagnostic Feature of Minimal Hepatic Encephalopathy in Patients with Cirrhosis
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DOI：
10.2169/internalmedicine.2116-18
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发表时间：
2019-01-01
影响因子：
1.2
通讯作者：
Takikawa, Yasuhiro
中科院分区：
文献类型：
--
作者：
Sato, Takuro;Endo, Kei;Takikawa, Yasuhiro
目的为预防公开性肝性脑病的发展，在准确诊断的基础上对轻度肝性脑病进行早期干预至关重要。本研究探讨磁共振弥散峰度成像（DKI）和弥散张量成像（DTI）对MHE脑结构异常的检测效果。目的是确认磁共振（MR）成像检测到的脑微结构异常是否可以用于MHE的诊断。方法对32例受试者进行3-T mri前瞻性检查。采用基于束的空间统计和弥散成像的兴趣区分析来比较有和无轻微肝性脑病患者的平均峰度（MK）、分数各向异性（FA）和平均弥散度（MD）值。诊断性能的检测MHE是评估与接收器的工作特性分析。结果10例患者经神经心理测试诊断为MHE。在排除不合适的受试者后，我们分析了9例MHE患者和14例非MHE患者。MHE患者在广泛的白质中有减少的MK。我们还发现MHE患者尾状核、壳核、苍白球和/或丘脑的MK显著降低。壳核MK在鉴别MHE患者和非MHE患者方面表现出最佳的诊断效能（截止值0.74，敏感性0.89，特异性0.86）。结论DKI检测MHE患者脑白质和基底节区变化较DTI灵敏。壳核的MK值可作为诊断无MHE的肝硬化患者的MHE的有用标记。
Objective To prevent the development of overt hepatic encephalopathy, the early intervention for minimal hepatic encephalopathy (MHE) based on an accurate diagnosis is essential. This study investigated whether or not magnetic resonance diffusion kurtosis imaging (DKI) and diffusion tensor imaging (DTI) could detect brain microstructure abnormalities in MHE. The aim was to confirm whether or not brain microstructure abnormalities detected by magnetic resonance (MR) imaging could be used for the diagnosis of MHE.Methods Thirty-two subjects were prospectively examined with a 3-T MR scanner. Tract-based spatial statistics and region of interest analyses of diffusion imaging were performed to compare the mean kurtosis (MK), fractional anisotropy (FA), and mean diffusivity (MD) values between patients with and without minimal hepatic encephalopathy. The diagnostic performance for the detection of MHE was assessed with a receiver operating characteristic analysis.Results Ten subjects were diagnosed with MHE by neuropsychological testing. After the exclusion of unsuitable subjects, we analyzed 9 subjects with MHE and 14 without MHE. The patients with MHE had a reduced MK in the widespread white matter. We also found significant decreases in the MK in the caudate nucleus, putamen, globus pallidus, and/or thalamus in the subjects with MHE. The MK in the putamen showed the best diagnostic performance for differentiating the subjects with MHE from those without MHE (cut-off value, 0.74; sensitivity, 0.89; specificity, 0.86).Conclusion DKI detects changes in the cerebral white matter and basal ganglia regions of patients with MHE more sensitively than DTI. The MK values in the putamen can be a useful marker for diagnosing MHE from cirrhotic patients without MHE.