Report No xxxx - Instytut Fizyki JÄ drowej PAN

USEFULNESS OF PROTON MAGNETIC RESONANCE
SPECTROSCOPY ( 1 H MRS) IN DIAGNOSIS OF SUBCLINICAL
HEPATIC ENCEPHALOPATY
1 R. Banyś, 2 A. Słowik, 1 M. Pasowicz, 3 I. Ciecko-Michalska, 2 M. Motyl, 1 M. Irzyk,
2 A. Szczudlik, 3 J. Bogdał
1
Center for Diagnosis and Rehabilitation Heart and Lung Disease The John Paul II
Hospital, Departments of 2 Neurology, and 3 Gastroenterology, Jagiellonian University,
Kraków, Poland
Introduction
Subclinical hepatic encephalopathy (SHE), is a disorder of cognitive functions in
patients with liver cirrhosis, detectable only during neuropsychological examination,
adversely affecting daily activity, and without any deficits during standard neurological
examination. The disorder affects up to 70% of patients with liver cirrhosis. Nuclear Magnetic
Resonance Spectroscopy ( 1 H MRS) is a fast developing, noninvasive method allowing the in
vivo evaluation of biochemical changes in human brain.
Aim
The aim of the study was to assess the usefulness of in vivo 1 H MRS detection of
metabolic abnormalities in brains of patients with SHE.
Method
In this study we included 22 patients with the diagnosis of SHE and 16 healthy
volunteers. MR imaging and 1 H MRS examinations were performed on 1.5 T Magnetom
Vision Plus and 1.5 T Magnetom Sonata Maestro Class (Siemens, Erlangen, Germany)
scanners with single voxel PRESS technique (TR = 1500 ms, TE = 135 ms, 256 acquistion
with the H 2 O signal suppression). Three voxels of 8 cm 3 were positioned in: 1)
predominantly white matter in the posteromedial parietial cortex, 2) predominantly gray
matter in the posterior occipital cortex, 3) globus pallidus.
Metabolite concentrations were calculated manually using integral Siemens software.
Peaks from myo-inositol (mI), choline (Cho) and N-acetyl-asparatate (NAA) were normalized
with respect to the creatine (Cr) peak (mI/Cr, Cho/Cr and NAA/Cr).
Results
Patients with SHE presented with significant reduction mI/Cr ratio as compared to
controls (0,138 vs. 0,044, p