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Research ArticleBrain
Open Access

Brain MR Imaging and 1H-MR Spectroscopy Changes in Patients with Extrahepatic Portal Vein Obstruction from Early Childhood to Adulthood

S.K. Yadav, S. Saksena, Anshu Srivastava, Arti Srivastava, V.A. Saraswat, M.A. Thomas, R.K.S. Rathore and R.K. Gupta
American Journal of Neuroradiology August 2010, 31 (7) 1337-1342; DOI: https://doi.org/10.3174/ajnr.A2045
S.K. Yadav
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S. Saksena
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Anshu Srivastava
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Arti Srivastava
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V.A. Saraswat
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M.A. Thomas
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R.K.S. Rathore
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R.K. Gupta
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Abstract

BACKGROUND AND PURPOSE: MR imaging and 1H-MR spectroscopy changes are well reported in cirrhotic patients, whereas they are inadequately reported in EHPVO. The aim of this study was to investigate age-related changes in brain MR imaging and metabolite profile in EHPVO with and without MHE and to explore any correlation of imaging and 1H-MR spectroscopy parameters with blood ammonia.

MATERIALS AND METHODS: Sixty-three patients with EHPVO (children, 7–12 years [n = 22], adolescents, 13–18 years [n = 15] and adults, 19–41 years [n = 26]) and 47 healthy age/sex-matched volunteers were studied. Neuropsychological tests, MR imaging, 1H-MR spectroscopy, and blood ammonia estimation were performed in all subjects.

RESULTS: Of 63 EHPVO patients, 25 (40%) who had MHE showed significantly increased MD, Glx, and blood ammonia in all 3 age groups; however, myo-inositol was significantly lower only in adults when compared with controls. MD positively correlated with blood ammonia and Glx in all age groups. Brain choline levels were normal in all patients with different age groups.

CONCLUSIONS: Increases in brain MD, Glx, and blood ammonia were associated with MHE in all age groups. Normal brain choline in EHPVO signifies healthy liver and may serve as a diagnostic marker for its differentiation from cirrhosis-induced encephalopathy. Significant decrease of myo-inositol in adults is probably due to cellular osmoregulation secondary to long-standing hyperammonemia.

Abbreviations

ALIC
anterior limb of internal capsule
ALT
alanine transaminase
ANOVA
analysis of variance
AST
aspartate transaminase
BA
blood ammonia
CG
cingulate gyrus
CN
caudate nucleus
DTI
diffusion tensor imaging
EHPVO
extrahepatic portal vein obstruction
FA
fractional anisotropy
FWM
frontal white matter
Glx
glutamine/glutamate
GP
globus pallidus
1H-MRS
1H-MR spectroscopy
MD
mean diffusivity
MHE
minimal hepatic encephalopathy
NAA
N-acetylaspartate
NS
not significant
OWM
occipital white matter
P
putamen
PLIC
posterior limb of internal capsule
PT
prothrombin time
S
significant
SB
serum bilirubin
Sp
splenium
T
thalamus
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American Journal of Neuroradiology: 31 (7)
American Journal of Neuroradiology
Vol. 31, Issue 7
1 Aug 2010
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Cite this article
S.K. Yadav, S. Saksena, Anshu Srivastava, Arti Srivastava, V.A. Saraswat, M.A. Thomas, R.K.S. Rathore, R.K. Gupta
Brain MR Imaging and 1H-MR Spectroscopy Changes in Patients with Extrahepatic Portal Vein Obstruction from Early Childhood to Adulthood
American Journal of Neuroradiology Aug 2010, 31 (7) 1337-1342; DOI: 10.3174/ajnr.A2045

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Brain MR Imaging and 1H-MR Spectroscopy Changes in Patients with Extrahepatic Portal Vein Obstruction from Early Childhood to Adulthood
S.K. Yadav, S. Saksena, Anshu Srivastava, Arti Srivastava, V.A. Saraswat, M.A. Thomas, R.K.S. Rathore, R.K. Gupta
American Journal of Neuroradiology Aug 2010, 31 (7) 1337-1342; DOI: 10.3174/ajnr.A2045
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