Document Detail

Cerebral diffusion tensor imaging and in vivo proton magnetic resonance spectroscopy in patients with fulminant hepatic failure.
MedLine Citation:
PMID:  17924951     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND AIM: Cerebral edema is a major complication in patients with fulminant hepatic failure (FHF). The aim of this study was to evaluate the metabolite alterations and cerebral edema in patients with FHF using in vivo proton magnetic resonance spectroscopy (MRS) and diffusion tensor imaging, and to look for its reversibility in survivors. METHODS: Ten FHF patients along with 10 controls were studied. Five of the 10 patients who recovered had a repeat imaging after three weeks. N-acetylaspartate, choline (Cho), glutamine (Gln), glutamine/glutamate (Glx), and myoinositol ratios were calculated with respect to creatine (Cr). Mean diffusivity (MD) and fractional anisotropy (FA) were calculated in different brain regions. RESULTS: Patients exhibited significantly increased Gln/Cr and Glx/Cr, and reduced Cho/Cr ratios, compared to controls. In the follow-up study, all metabolite ratios were normalized except Glx/Cr. Significantly decreased Cho/Cr were observed in deceased patients compared to controls. In patients, significantly decreased MD and FA values were observed in most topographical locations of the brain compared to controls. MD and FA values showed insignificant increase in the follow-up study compared to their first study. CONCLUSIONS: We conclude that the Cho/Cr ratio appears to be an in vivo marker of prognosis in FHF. Decreased MD values suggest predominant cytotoxic edema may be present. Persistence of imaging and MRS abnormalities at three weeks' clinical recovery suggests that metabolic recovery may take longer than clinical recovery in FHF patients.
Sona Saksena; Vijan Rai; Vivek Anand Saraswat; Ramkishore Singh Rathore; Ankur Purwar; Manoj Kumar; M Albert Thomas; Rakesh Kumar Gupta
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2007-10-09
Journal Detail:
Title:  Journal of gastroenterology and hepatology     Volume:  23     ISSN:  1440-1746     ISO Abbreviation:  J. Gastroenterol. Hepatol.     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-08-14     Completed Date:  2008-10-30     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8607909     Medline TA:  J Gastroenterol Hepatol     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  e111-9     Citation Subset:  IM    
Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
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MeSH Terms
Aspartic Acid / analogs & derivatives,  metabolism
Biological Markers / metabolism
Case-Control Studies
Cerebrovascular Circulation*
Choline / metabolism*
Creatine / metabolism*
Diffusion Magnetic Resonance Imaging*
Glutamic Acid / metabolism
Glutamine / metabolism
Hepatic Encephalopathy / metabolism,  mortality,  pathology*,  physiopathology
Inositol / metabolism
Magnetic Resonance Spectroscopy*
Middle Aged
Parietal Lobe / metabolism,  pathology*,  physiopathology
Time Factors
Reg. No./Substance:
0/Biological Markers; 0/Protons; 56-84-8/Aspartic Acid; 56-85-9/Glutamine; 56-86-0/Glutamic Acid; 57-00-1/Creatine; 62-49-7/Choline; 6917-35-7/Inositol; 997-55-7/N-acetylaspartate

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