European Radiology

, Volume 27, Issue 11, pp 4699–4709 | Cite as

Severity-specific alterations in CBF, OEF and CMRO2 in cirrhotic patients with hepatic encephalopathy

  • Gang Zheng
  • Hanzhang Lu
  • Wenkui Yu
  • Song Luo
  • Ya Liu
  • Wei Liu
  • Hui Liu
  • Long Wu
  • Lijuan Zheng
  • Xiang Kong
  • Long Jiang ZhangEmail author
  • Guang Ming Lu
Head and Neck



To assess how the severity of hepatic encephalopathy (HE) affects perfusion and metabolic changes in cirrhotic patients and the association between severity and liver disease and anemia.


The study groups comprised 31 healthy subjects and 33 cirrhotic patients who underwent MR examinations, and blood and neuropsychological tests. Of the cirrhotic patients, 14 were unaffected, and 11 had covert HE (CHE) and 8 overt HE (OHE). Global cerebral blood flow (CBF), oxygen extraction fraction (OEF), and metabolic rate of oxygen (CMRO2) were noninvasively measured by phase-contrast and T2-relaxation-under-spin-tagging MRI. Correlations were performed between MR measurements, hematocrits, ammonia levels, Child-Pugh scores and neuropsychological test scores.


Compared with the values in healthy subjects, CBF was higher in unaffected patients, the same in CHE patients and lower in OHE patients, OEF was higher in all patients, and CMRO2 was the same in unaffected and CHE patients and lower in OHE patients. Hematocrit was negatively correlated with CBF and OEF, but not with CMRO2. Ammonia level was negatively correlated with CBF and CMRO2, and Child-Pugh score was negatively correlated with CMRO2.


The severity-associated alterations in cirrhotic patients indicate that homeostasis of oxygen delivery and oxidative metabolism in HE is regulated by multiple mechanisms. These physiological alterations appeared to be associated with the degree of anemia, ammonia level, and liver function.

Key Points

CBF, OEF and CMRO2 did not change monotonically with HE progression.

Anemia possibly contributed to CBF and OEF changes in cirrhotic patients.

Liver dysfunction mainly contributed to changes in CMRO2 in cirrhotic patients.


Hepatic encephalopathy Cirrhosis Cerebral blood flow Oxygen extraction fraction Cerebral metabolic rate of oxygen 



Cerebral blood flow


Covert hepatic encephalopathy


Cerebral metabolic rate of oxygen


Hepatic encephalopathy


Mini mental state examination


Oxygen extraction fraction


Overt hepatic encephalopathy


Phase-contrast MRI


Psychometric hepatic encephalopathy score




Compliance with ethical standards


The scientific guarantor of this publication is Long Jiang Zhang.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.


This study received funding from the National Natural Science Foundation of China (grants 81671667, 81471644 and 81101039 to G.Z. and grants 81322020, 81230032 and 81171313 to L.J.Z.), and the China Postdoctoral Science Foundation (grant 2016T90445, 2014T71014 and 2015M570436 to G.Z.).

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects in this study.

Ethical approval

Institutional Review Board approval was obtained.


• Prospective

• Cross sectional study

• Performed at one institution


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Copyright information

© European Society of Radiology 2017

Authors and Affiliations

  • Gang Zheng
    • 1
    • 2
  • Hanzhang Lu
    • 3
  • Wenkui Yu
    • 4
  • Song Luo
    • 1
  • Ya Liu
    • 1
    • 2
  • Wei Liu
    • 5
  • Hui Liu
    • 6
  • Long Wu
    • 1
  • Lijuan Zheng
    • 1
  • Xiang Kong
    • 1
  • Long Jiang Zhang
    • 1
    Email author
  • Guang Ming Lu
    • 1
  1. 1.Department of Medical Imaging, Jinling HospitalMedical School of Nanjing UniversityNanjingChina
  2. 2.College of Civil AviationNanjing University of Aeronautics and AstronauticsNanjingChina
  3. 3.The Russell H. Morgan Department of Radiology & Radiological ScienceJohns Hopkins UniversityBaltimoreUSA
  4. 4.Institute of General Surgery, Jinling HospitalMedical School of Nanjing UniversityNanjingChina
  5. 5.Siemens Shenzhen Magnetic Resonance Ltd.ShenzhenChina
  6. 6.Siemens MR NEA Collaboration, Siemens Ltd., ChinaShanghaiChina

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