Early detection of hepatic encephalopathy after transjugular intrahepatic portsystemic shunt using multiparametric magnetic resonance with spectroscopy

Laura Greco; Fabrizio Chegai; Maria Claudia Pensabene; Laura De Corato; Enrico Pampana; Ilaria Lenci; Francesco Garaci; Roberto Floris; Milena Melis

doi:10.1016/j.ejro.2019.09.002

Early detection of hepatic encephalopathy after transjugular intrahepatic portsystemic shunt using multiparametric magnetic resonance with spectroscopy

Eur J Radiol Open. 2019 Dec 2:6:350-357. doi: 10.1016/j.ejro.2019.09.002. eCollection 2019.

Authors

Laura Greco¹, Fabrizio Chegai¹, Maria Claudia Pensabene¹, Laura De Corato¹, Enrico Pampana¹, Ilaria Lenci¹, Francesco Garaci¹, Roberto Floris¹, Milena Melis¹

Affiliation

¹ Department of Biomedicine and Prevention, UOC of Diagnostic Imaging, University of Rome, "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy.

Abstract

Background: Hepatic encephalopathy (HE) is a complication of transjugular intrahepatic portosystemic shunt (TIPS).

Aims: Extend the knowledge about the early detection of multiple brain metabolic abnormalities following TIPS; these abnormalities can be detected and managed prior to the clinical manifestation of HE with use of Multiparametric Magnetic Resonance with Spectroscopy.

Methods: 12 cirrhotic Patients underwent TIPS; each Patient underwent a 3 T MRI evaluation before and after TIPS. The spectroscopic images were processed measuring the values of the metabolites N-acetylaspartate (NAA) - Glutamine / Glutamate (Glx) - Colina (Cho) - Myinositol (mI) at the level of the nuclei of the base.

Results: Spectroscopic examination performed before the TIPS procedure showed low values of Cho and Mi, instead following the procedure: an increase in the Glx value, a mean reduction in the values of Cho and mI, a statistically significant reduction in the Cho / Creatine ratio, in the mI / Creatine ratio and an increase of the Glx / Creatine ratio.

Conclusions: Our study demonstrated the efficacy of spectroscopy in Patient subjected to TIPS. MR 3 T with spectroscopy can become a valid tool for monitor the dynamics of changes in brain metabolism after TIPS and to provide an early diagnosis of HE allowing an early treatment.

Keywords: Hepatic encephalopathy (HE); Multiparametric magnetic resonance; Spectroscopy; Transjugular intrahepatic portosystemic shunt (TIPS).