Functional imaging of the brain in patients with liver cirrhosis

被引:44
作者
Weissenborn, K [1 ]
Bokemeyer, M
Ahl, B
Fischer-Wasels, D
Giewekemeyer, K
van den Hoff, J
Köstler, H
Berding, G
机构
[1] Hannover Med Sch, Dept Neurol, D-30623 Hannover, Germany
[2] Hannover Med Sch, Dept Neuroradiol, D-30623 Hannover, Germany
[3] Hannover Med Sch, Dept Nucl Med, D-30623 Hannover, Germany
关键词
hepatic encephalopathy; brain imaging; MRI; MRS; SPECT; PET;
D O I
10.1023/B:MEBR.0000043976.17500.8e
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Brain imaging techniques have provided substantial insight into the pathophysiology of hepatic encephalopathy ( HE). Magnetic resonance imaging gave hint to the fact that there is an increased deposition of manganese especially in the basal ganglia. Single photon emission computed tomography ( SPECT) and positron emission tomography ( PET) showed that the preference of the basal ganglia might be due to differences in regional cerebral blood flow and an additional redistribution of blood flow from the cortex to subcortical regions in cirrhotics. PET studies using ammonia as tracer showed that the cerebral metabolism of ammonia and the permeability of the blood brain barrier for ammonia is increased in cirrhotic patients compared to healthy controls. The regional ammonia supply is in accordance with the regional blood flow. In accordance with these findings fluorodesoxyglucose-PET-studies of the brain in cirrhotics showed characteristic alterations of glucose utilisation in the patients with a relative decrease of the glucose utilisation of the cingulate gyrus, the frontomedial, frontolateral, and parieto-occipital cortex, while the glucose utilisation of the basal ganglia, the hippocampus, and the cerebellum was relatively increased. These findings fit well with the clinical characteristics of early stages of HE such as deficits in attention, visuo-spatial orientation, visuo-constructive abilities, motor speed, and accuracy.
引用
收藏
页码:269 / 280
页数:12
相关论文
共 59 条
[31]   ALTERED CEREBRAL BLOOD-FLOW AND GLUCOSE-METABOLISM IN PATIENTS WITH LIVER-DISEASE AND MINIMAL ENCEPHALOPATHY [J].
LOCKWOOD, AH ;
YAP, EWH ;
RHOADES, HM ;
WONG, WH .
JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM, 1991, 11 (02) :331-336
[32]   Correlations between cerebral glucose metabolism and neuropsychological test performance in nonalcoholic cirrhotics [J].
Lockwood, AH ;
Weissenborn, K ;
Bokemeyer, M ;
Tietge, U ;
Burchert, W .
METABOLIC BRAIN DISEASE, 2002, 17 (01) :29-40
[33]   CEREBRAL AMMONIA METABOLISM IN PATIENTS WITH SEVERE LIVER-DISEASE AND MINIMAL HEPATIC-ENCEPHALOPATHY [J].
LOCKWOOD, AH ;
YAP, EWH ;
WONG, WH .
JOURNAL OF CEREBRAL BLOOD FLOW AND METABOLISM, 1991, 11 (02) :337-341
[34]   An image of the brain in patients with liver disease [J].
Lockwood, AH ;
Weissenborn, K ;
Butterworth, RF .
CURRENT OPINION IN NEUROLOGY, 1997, 10 (06) :525-533
[35]  
LOCKWOOD AH, 1993, HEPATOLOGY, V18, P1061
[36]   MORPHOMETRIC AND DENSITOMETRIC INVESTIGATIONS OF PROTOPLASMIC ASTROCYTES AND NEURONS IN HUMAN HEPATIC-ENCEPHALOPATHY [J].
MARTIN, H ;
VOSS, K ;
HUFNAGL, P ;
WACK, R ;
WASSILEW, G .
EXPERIMENTAL PATHOLOGY, 1987, 32 (04) :241-250
[37]   HYPERINTENSE BASAL GANGLIA ON T1-WEIGHTED MR IMAGES IN PATIENTS RECEIVING PARENTERAL-NUTRITION [J].
MIROWITZ, SA ;
WESTRICH, TJ ;
HIRSCH, JD .
RADIOLOGY, 1991, 181 (01) :117-120
[38]   Cerebral magnetic resonance imaging in patients with chronic liver disease [J].
Morgan, MY .
METABOLIC BRAIN DISEASE, 1998, 13 (04) :273-290
[39]   MR imaging and 1H spectroscopy of brain metabolites in hepatic encephalopathy:: Time-course of renormalization after liver transplantation [J].
Naegele, T ;
Grodd, W ;
Viebahn, R ;
Seeger, U ;
Klose, U ;
Seitz, D ;
Kaiser, S ;
Mader, I ;
Mayer, J ;
Lauchart, W ;
Gregor, M ;
Voigt, K .
RADIOLOGY, 2000, 216 (03) :683-691
[40]  
NELSON K, 1993, BRIT J IND MED, V50, P510