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The role of magnetic resonance imaging and spectroscopy in hepatic encephalopathy

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Abstract

Hepatic encephalopathy (HE) is a diverse manifestation of acute and chronic liver failure, ranging from cognitive impairment, only detectable on psychometric evaluation through to confusion, coma and death from cerebral oedema. While there is widespread acceptance of its importance, there is little consensus on how best to diagnose and monitor HE. Clinical descriptions, psychometric testing, electroencephalography and magnetic resonance (MR) imaging (and lately, MR spectroscopy) have all been proposed. MR techniques, in contrast to other modalities, have the benefit of objectivity and of being able to interrogate the brain directly with respect to changes in brain size, function and the metabolic disturbances thought to underlie HE, particularly in the context of astrocyte swelling. Modern clinical MRI scanners with multinuclear MR spectroscopy capabilities and brain mapping software can demonstrate structural and functional cellular changes using volumetric MRI, magnetization transfer MRI, diffusion-weighting MRI, functional MRI with oxygenation measurements and in vivo and in vitro 1H and 31P MR spectroscopy. This review describes the relative merits of these techniques and provides guidance on the directions for future research and translation into clinical practice.

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Abbreviations

ADC:

apparent diffusion coefficient

ALF:

acute liver failure

ATP:

adenosine triphosphate

BOLD:

blood oxygenation level dependent

CLF:

chronic liver failure

DWI:

diffusion-weighted imaging

FA:

fractional anisotropy

fMRI:

functional magnetic resonance imaging

HE:

hepatic encephalopathy

MHE:

minimal hepatic encephalopathy

MRI:

magnetic resonance imaging

MRS:

magnetic resonance spectroscopy

MTR:

magnetization transfer ratio

NAA:

N-acetyl aspartate

Pi:

inorganic phosphate

PDE:

phosphodiesters

PME:

phosphomonoesters

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Acknowledgements

The United Kingdom NIHR Biomedical Research Facility provided infrastructure support to both MJWM and SDT-R. The Wellcome Trust (London, UK) provided financial support to MJWM. We are grateful to Professors Howard Thomas and Claude Marcus, Drs Bob Grover, Jane Cox, Marzena Wylezinska-Arridge, David Larkman, Daniel M. Forton, Nayna Patel, Mary Crossey and Julie Fitzpatrick for useful discussions.

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  1. Liver and Anti-Viral Centre, Department of Hepatology, Division of Medicine, Imperial College London, 10th Floor QEQM Building, St Mary’s Hospital Campus, South Wharf Road, London, W2 1NY, United Kingdom

    Mark J. W. McPhail & Simon D. Taylor-Robinson

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Correspondence to Simon D. Taylor-Robinson.

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McPhail, M.J.W., Taylor-Robinson, S.D. The role of magnetic resonance imaging and spectroscopy in hepatic encephalopathy. Metab Brain Dis 25, 65–72 (2010). https://doi.org/10.1007/s11011-010-9171-4

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