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Disrupted topological organization of brain structural network associated with prior overt hepatic encephalopathy in cirrhotic patients

  • Magnetic Resonance
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Abstract

Objectives

To investigate structural brain connectome alterations in cirrhotic patients with prior overt hepatic encephalopathy (OHE).

Methods

Seventeen cirrhotic patients with prior OHE (prior-OHE), 18 cirrhotic patients without prior OHE (non-prior-OHE) and 18 healthy controls (HC) underwent diffusion tensor imaging. Neurocognitive functioning was assessed with Psychometric Hepatic Encephalopathy Score (PHES). Using a probabilistic fibre tracking approach, we depicted the whole-brain structural network as a connectivity matrix of 90 regions (derived from the Automated Anatomic Labeling atlas). Graph theory-based analyses were performed to analyse topological properties of the brain network.

Results

The analysis of variance showed significant group effects on several topological properties, including network strength, global efficiency and local efficiency. A progressive decrease trend for these metrics was found from non-prior-OHE to prior-OHE, compared with HC. Among the three groups, the regions with altered nodal efficiency were mainly distributed in the frontal and occipital cortices, paralimbic system and subcortical regions. The topological metrics, such as network strength and global efficiency, were correlated with PHES among cirrhotic patients.

Conclusions

The cirrhotic patients developed structural brain connectome alterations; this is aggravated by prior OHE episode. Disrupted topological organization of the brain structural network may account for cognitive impairments related to prior OHE.

Key points

• Altered structural brain connectome is found in cirrhotic patients.

• Structural brain connectome alterations could be aggravated by prior-OHE episode.

• Altered structural brain connectome may account for cognitive impairments associated with prior OHE.

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Abbreviations

AAL:

Automated Anatomical Labeling

ACG:

Anterior cingulate and paracingulate gyri

AUC:

Area under the curve

DCG:

Median cingulate and paracingulate gyri

DMN:

Default mode network

DST:

Digit symbol test

DTI:

Diffusion tensor imaging

IFGtriang:

Inferior frontal gyrus-triangular part

IOG:

Inferior occipital gyrus

LTT:

Line tracing test

MMSE:

Mini-Mental State Examination

NCT-A:

Number connection test A

NCT-B:

Number connection test B

OHE:

Overt hepatic encephalopathy

ORBinf:

Inferior frontal gyrus-orbital part

ORBsup:

Superior frontal gyrus-orbital part

PCG:

Posterior cingulate gyrus

PCL:

Paracentral lobule

PHES:

Psychometric Hepatic Encephalopathy Score

REC:

Gyrus rectus

SDT:

Serial dotting test

SFGdor:

Dorsolateral superior frontal gyrus

SFGmed:

Medial superior frontal gyrus

SMA:

Supplementary motor area

SOG:

Superior occipital gyrus

STG:

Superior temporal gyrus

WM:

White matter

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Author information

Authors and Affiliations

  1. Department of Radiology, Fujian Medical University Union Hospital, Fuzhou, 350001, China

    Hua-Jun Chen & Lan Li

  2. Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China

    Hua-Jun Chen & Hai-Bin Shi

  3. Department of Infectious Diseases, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, China

    Long-Feng Jiang

  4. Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, 21201, USA

    Rong Chen

  5. Advanced Innovation Center for Intelligent Robots and Systems, Beijing Institute of Technology, Beijing, 100081, China

    Rong Chen

Authors
  1. Hua-Jun Chen
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  2. Hai-Bin Shi
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  4. Lan Li
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Corresponding authors

Correspondence to Hua-Jun Chen, Hai-Bin Shi or Rong Chen.

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Guarantor

The scientific guarantor of this publication is Hua-Jun Chen.

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.

Funding

This study has received funding by the National Natural Science Foundation of China (No. 81501450) and the China Postdoctoral Science Foundation

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

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

Ethical approval

Institutional review board approval was obtained.

Methodology

•retrospective

•cross-sectional study

•performed at one institution

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Chen, HJ., Shi, HB., Jiang, LF. et al. Disrupted topological organization of brain structural network associated with prior overt hepatic encephalopathy in cirrhotic patients. Eur Radiol 28, 85–95 (2018). https://doi.org/10.1007/s00330-017-4887-8

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  • DOI: https://doi.org/10.1007/s00330-017-4887-8

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