Proton Magnetic Resonance Spectroscopic Findings in Cirrhotic Patients with Hepatic Encephalopathy : The Significance of Decreased Myoinositol / Creatine Ratio

Chung, Young Hwa; Lee, Yung Sang; Lee, Jung Hee; Suh, Dong Jin; Seo, Dong Wan; Kwon, Kyung Su; Yeom, Keong Hun; Lim, Tae Whan

Abstract

BACKGROUND AND AIMS: Proton magnetic resonance spectroscopy has been applied to assess the metabolic changes of the brain in patients with liver cirrhosis. Decrease in myoinositol (MI)/ creatine (Cr) ratio has been frequently observed in cirrhotic patients with hepatic encephalopathy. The aim of this study is to clarify whether decrease in MI/Cr ratio reflects the severity of hepatic encephalopathy.
METHODS
Proton magnetic resonance spectroscopy was performed for 81 cirrhotic patients with (n=41) and without (n=40) encephalopathy and 34 controls after the collection of clinical and biochemical data.
RESULTS
The MI/Cr ratios in the basal ganglia and parietal white matter were significantly lower in cirrhotic patients compared with those in controls. The MI/Cr ratios in the basal ganglia and parietal white matter were significantly lower in cirrhotic patients with encephalopathy tlhan in those without encephalopathy. However, in cirrhotic patients who were in Child class C and showed normal serum osmolarity, there was no significant difference of MI/Cr ratio between patients with (n=24) and without encephalopathy (n=20). In addition, the MI/Cr ratios in the basal ganglia and parietal white matter are not significantly different according to the stage of the hepatic encephalopathy.
CONCLUSIONS
The decrease in MI/Cr ratio observed in cirrhotic patients is not likely to reflect the severity of hepatic encephalopathy or acute alteration of consciousness level.