Regional differences in cerebral blood flow and cerebral ammonia metabolism in patients with cirrhosis
Regional differences in cerebral blood flow and cerebral ammonia metabolism in patients with cirrhosis
复制标题
DOI：
10.1002/hep.20290
复制
发表时间：
2004-07-01
期刊：
影响因子：
13.5
通讯作者：
Burchert, W
中科院分区：
文献类型：
--
作者：
Ahl, B;Weissenborn, K;Burchert, W
临床和组织病理学研究结果提示，大脑对肝硬化代谢变化的敏感性存在区域差异。本研究的目的是检测肝硬化及0 - I级肝性脑病（HE）患者脑氨代谢的区域差异。进行了N - 13 - 氨、O - 15 - 水正电子发射断层扫描（PET）和磁共振成像（MRI）。在与患者的MRI研究进行交互式配准后，从所需参数的图像中得出几个感兴趣区域的脑血流量（CBF）和初始脑氨摄取率（K1）的定量值。脑血流量（CBF，毫升/毫升/分钟）、K1（毫升/毫升/分钟）以及氨摄取分数（K1/CBF）显示出明显的区域差异，丘脑、豆状核和小脑的水平最高。总之，脑氨摄取的区域差异与肝硬化患者大脑组织病理学变化的分布以及肝性脑病的临床特征相符，其特征是基底节和小脑功能障碍的体征以及相应的功能损害体征，特别是额叶皮质和扣带回的功能损害体征。
Clinical and histopathological findings hint at regional differences in the brain's sensitivity to metabolic changes in cirrhosis. The aim of the present study was to examine regional differences in cerebral ammonia metabolism in patients with cirrhosis and grade 0-to-I hepatic encephalopathy (HE). N-13-ammonia, O-15-water positron emission tomography (PET) and magnetic resonance imaging (MRI) were performed. Quantitative values of cerebral blood flow (CBF) and the initial cerebral ammonia uptake rate (K1) were derived for several regions of interest from images of the desired parameters after interactive coregistration with the patients' MRI-studies. CBF (mL/mL/min), K1 (mL/mL/min), and the ammonia extraction fraction (K1/CBF) showed marked regional variance with the highest levels in the thalamus, the lenticular nucleus, and the cerebellum. In conclusion, the regional differences in cerebral ammonia uptake correspond to the distribution of histopathological changes in the brain of patients with cirrhosis as well as clinical features of HE, characterized by signs of basal ganglia and cerebellar dysfunction with corresponding signs of functional impairment, especially of the frontal cortex and cingulate gyrus.