Identifying Minimal Hepatic Encephalopathy: A New Perspective from Magnetic Resonance Imaging

医学 磁共振成像 亚临床感染 肝性脑病 彗差(光学) 脑病 放射科 调车 神经心理学 体内磁共振波谱 神经影像学 重症监护医学 内科学 肝硬化 精神科 物理 认知 光学
作者
Yisong Wang,Longtao Yang,Youlan Shang,Yijie Huang,Chao Ju,Hairong Zheng,Wei Zhao,Jun Liu
出处
期刊:Journal of Magnetic Resonance Imaging [Wiley]
被引量:1
标识
DOI:10.1002/jmri.29179
摘要

Type C hepatic encephalopathy (HE) is a condition characterized by brain dysfunction caused by liver insufficiency and/or portal‐systemic blood shunting, which manifests as a broad spectrum of neurological or psychiatric abnormalities, ranging from minimal HE (MHE), detectable only by neuropsychological or neurophysiological assessment, to coma. Though MHE is the subclinical phase of HE, it is highly prevalent in cirrhotic patients and strongly associated with poor quality of life, high risk of overt HE, and mortality. It is, therefore, critical to identify MHE at the earliest and timely intervene, thereby minimizing the subsequent complications and costs. However, proper and sensitive diagnosis of MHE is hampered by its unnoticeable symptoms and the absence of standard diagnostic criteria. A variety of neuropsychological or neurophysiological tests have been performed to diagnose MHE. However, these tests are nonspecific and susceptible to multiple factors (eg, aging, education), thereby limiting their application in clinical practice. Thus, developing an objective, effective, and noninvasive method is imperative to help detect MHE. Magnetic resonance imaging (MRI), a noninvasive technique which can produce many objective biomarkers by different imaging sequences (eg, Magnetic resonance spectroscopy, DWI, rs‐MRI, and arterial spin labeling), has recently shown the ability to screen MHE from NHE (non‐HE) patients accurately. As advanced MRI techniques continue to emerge, more minor changes in the brain could be captured, providing new means for early diagnosis and quantitative assessment of MHE. In addition, the advancement of artificial intelligence in medical imaging also presents the potential to mine more effective diagnostic biomarkers and further improves the predictive efficiency of MHE. Taken together, advanced MRI techniques may provide a new perspective for us to identify MHE in the future. Level of Evidence 3 Technical Efficacy Stage 2
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