Decreased Mean Kurtosis in the Putamen is a Diagnostic Feature of Minimal Hepatic Encephalopathy in Patients with Cirrhosis
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- Sato Takuro
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Japan
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- Endo Kei
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Japan
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- Kakisaka Keisuke
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Japan
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- Suzuki Yuji
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Japan
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- Kooka Yohei
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Japan
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- Sawara Kei
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Japan
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- Ito Kenji
- Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Japan
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- Sasaki Makoto
- Division of Ultrahigh Field MRI, Institute for Biomedical Sciences, Iwate Medical University, Japan
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- Takikawa Yasuhiro
- Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Japan
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説明
<p>Objective To prevent the development of overt hepatic encephalopathy, the early intervention for minimal hepatic encephalopathy (MHE) based on an accurate diagnosis is essential. This study investigated whether or not magnetic resonance diffusion kurtosis imaging (DKI) and diffusion tensor imaging (DTI) could detect brain microstructure abnormalities in MHE. The aim was to confirm whether or not brain microstructure abnormalities detected by magnetic resonance (MR) imaging could be used for the diagnosis of MHE. </p><p>Methods Thirty-two subjects were prospectively examined with a 3-T MR scanner. Tract-based spatial statistics and region of interest analyses of diffusion imaging were performed to compare the mean kurtosis (MK), fractional anisotropy (FA), and mean diffusivity (MD) values between patients with and without minimal hepatic encephalopathy. The diagnostic performance for the detection of MHE was assessed with a receiver operating characteristic analysis. </p><p>Results Ten subjects were diagnosed with MHE by neuropsychological testing. After the exclusion of unsuitable subjects, we analyzed 9 subjects with MHE and 14 without MHE. The patients with MHE had a reduced MK in the widespread white matter. We also found significant decreases in the MK in the caudate nucleus, putamen, globus pallidus, and/or thalamus in the subjects with MHE. The MK in the putamen showed the best diagnostic performance for differentiating the subjects with MHE from those without MHE (cut-off value, 0.74; sensitivity, 0.89; specificity, 0.86). </p><p>Conclusion DKI detects changes in the cerebral white matter and basal ganglia regions of patients with MHE more sensitively than DTI. The MK values in the putamen can be a useful marker for diagnosing MHE from cirrhotic patients without MHE. </p>
収録刊行物
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- Internal Medicine
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Internal Medicine 58 (9), 1217-1224, 2019-05-01
一般社団法人 日本内科学会