Regional cerebral blood flow changes in patients with cirrhosis assessed with 99mTc-HM-PAO single-photon emission computed tomography:: effect of liver transplantation

被引:38
作者
Dam, M
Burra, P
Tedeschi, U
Cagnin, A
Chierichetti, F
Ermani, M
Ferlin, G
Naccarato, R
Pizzolato, G
机构
[1] Univ Padua, Dept Neurol & Psychiat, I-35128 Padua, Italy
[2] Univ Padua, Dept Gastroenterol, I-35128 Padua, Italy
[3] Univ Padua, Dept Clin Surg, I-35128 Padua, Italy
关键词
cerebral blood flow Tc-99m-hexamethylpropyleneamineoxime; liver cirrhosis; liver transplantation; single-photon emission computed tomography;
D O I
10.1016/S0168-8278(98)80181-5
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background/Aims: Previous studies showed contrasting results with regard to alterations of regional cerebral blood flow/metabolism in subjects with liver cirrhosis. The aim of the study was to extend these findings in a larger series of patients. In addition, me wanted to determine whether such alterations are reversed by successful liver transplantation. Methods: The study group comprised 23 patients with liver cirrhosis and 13 normal controls. At entry to the study, all subjects underwent a complete neurological examination, EEG recordings and SPECT scanning. The severity of liver disease was determined according to the Child-Pugh score. Fourteen patients underwent a second SPECT examination 1 year after liver transplantation. Results: Significant rCBF reductions, ranging from 6% to 7%, were found in the majority of the cortical regions of the whole group of patients with cirrhosis, as compared to controls. These reductions were more diffuse in patients with alcoholic liver disease, comprising almost all the assayed regions. Liver transplantation normalized cortical rCBF deficits so that postoperative perfusion indexes were superimposable on control values. However, the frontal cortex remained significantly more impaired in patients with alcoholic cirrhosis than in those with non-alcoholic cirrhosis. The differences in frontal rCBF between the two groups of patients ranged from 6 to 11%. Conclusions: Liver cirrhosis was associated with rCBF defects that depend upon the etiology of liver disease and that subsided after successful liver transplantation. The frontal defects in alcoholic cirrhosis either before or after surgery may imply a neurotoxic, possibly irreversible, action of ethanol.
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页码:78 / 84
页数:7
相关论文
共 38 条
[1]  
ANDERSON U, 1988, J PRACTICE THEORY, V8, P23
[2]   BRAIN MORPHOLOGIC CHARACTERISTICS OF CIRRHOTIC ALCOHOLICS AND CIRRHOTIC NONALCOHOLICS - AN MRI STUDY [J].
BARTHAUER, L ;
TARTER, R ;
HIRSCH, W ;
VANTHIEL, D .
ALCOHOLISM-CLINICAL AND EXPERIMENTAL RESEARCH, 1992, 16 (05) :982-985
[3]   The neurobiology of hepatic encephalopathy [J].
Butterworth, RF .
SEMINARS IN LIVER DISEASE, 1996, 16 (03) :235-244
[4]  
CASTELL DO, 1971, GASTROENTEROLOGY, V60, P33
[5]  
CONN HO, 1992, THERAPY IN LIVER DISEASES, P277
[6]   LOCAL CEREBRAL GLUCOSE-METABOLISM IN RATS WITH CHRONIC PORTACAVAL SHUNTS [J].
CRUZ, NF ;
DUFFY, TE .
JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM, 1983, 3 (03) :311-320
[7]  
Damasio H., 1989, Lesion analysis in neuropsychology
[8]   CEREBRAL VENTRICULAR ENLARGEMENT - CHRONIC-ALCOHOLICS EXAMINED BY COMPUTERIZED TOMOGRAPHY [J].
FOX, JH ;
RAMSEY, RG ;
HUCKMAN, MS ;
PROSKE, AE .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1976, 236 (04) :365-368
[9]   PSYCHOMOTOR PERFORMANCE DEFECTS IN CIRRHOTIC-PATIENTS WITHOUT OVERT ENCEPHALOPATHY [J].
GILBERSTADT, SJ ;
GILBERSTADT, H ;
ZIEVE, L ;
BUEGEL, B ;
COLLIER, RO ;
MCCLAIN, CJ .
ARCHIVES OF INTERNAL MEDICINE, 1980, 140 (04) :519-521
[10]   CEREBELLAR AND FRONTAL HYPOMETABOLISM IN ALCOHOLIC CEREBELLAR DEGENERATION STUDIED WITH POSITRON EMISSION TOMOGRAPHY [J].
GILMAN, S ;
ADAMS, K ;
KOEPPE, RA ;
BERENT, S ;
KLUIN, KJ ;
MODELL, JG ;
KROLL, P ;
BRUNBERG, JA .
ANNALS OF NEUROLOGY, 1990, 28 (06) :775-785