Proton magnetic resonance spectroscopy of the brain in symptomatic and asymptomatic patients with liver cirrhosis

Background & Aims: Hepatic encephalopathy (HE) is associated with typical changes of cerebral metabolite pattern observed by proton magnetic resonance (MR) spectroscopy consisting of a depletion of myo-inositol and an increase of glutamine. The aim of this study was to determine whether abnormalities in brain metabolism in neurologically asymptomatic patients with liver cirrhosis can be detected by spectroscopy. Methods: In a prospective study, 39 patients with liver cirrhosis were examined clinically according to standardized neuropsychological tests to define whether overt, subclinical, or no hepatic encephalopathy was present. All patients underwent proton MR spectroscopy at short echo times. Results: Spectroscopy allowed for the diagnosis of subclinical HE in 4 of 4 cases and of overt HE in 10 of 11 cases. In 24 cases of mere liver cirrhosis and normal neuropsychological testing, a typical metabolic pattern with a depletion of myo-inositol and an increased glutamine peak were found. A good correlation between the glutamine signal and the clinical grading was found. Conclusions: Proton MR spectroscopy allows for the diagnosis of HE and subclinical HE, also shows the typical pathological metabolite pattern in patients with cirrhotic livers without subclinical HE, and might be more sensitive than neuropsychological testing. Glutamine could serve as a spectroscopic marker for the clinical state of the patients.