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The brain following transjugular intrahepatic portosystemic shunt: the perspective from neuroimaging

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Abstract

Hepatic encephalopathy (HE) is a common complication after implantation of a transjugular intrahepatic portosystemic shunt (TIPS). Neuroimaging offers a variety of techniques for non-invasive evaluation of alterations in metabolism, as well as structural and functional changes of the brain in patients after TIPS implantation. In this article, we review the epidemiology and pathophysiology of post-TIPS HE. The potential of neuroimaging including positron emission tomography and multimodality magnetic resonance imaging to investigate the pathophysiology of post-TIPS HE is presented. We also give a perspective on the role of neuroimaging in this field.

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Abbreviations

ADC:

Apparent diffusion coefficient

ALFF:

Amplitude of low frequency fluctuation

ASL:

Arterial spin labeling

BOLD:

Blood oxygenation level-dependent

CBF:

Cerebral blood flow

CMRA:

Cerebral metabolism rate of ammonia

CMRO2 :

Metabolic rate of oxygen

DTI:

Diffusion tensor imaging

DWI:

Diffusion weighted imaging

FA:

Fractional anisotropy

fMRI:

Functional magnetic resonance imaging

HE:

Hepatic encephalopathy

MD:

Mean diffusivity

PET:

Positron emission tomography

ReHo:

Regional homogeneity

SPECT:

Single photon emission computed tomography

TIPS:

Transjugular intrahepatic portosystemic shunt

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Acknowledgments

Supported by Grants from National Natural Science Foundation of China, Nos. 30700194, 81322020 and 81230032 (to Zhang LJ); Grant No.81101039 (to Zheng G); Program for New Century Excellent Talents in University, No. NCET-12-0260 (to Zhang LJ)

Author contributions

Zhang LJ and Lu GM designed the research; Chen HJ, Zheng G, Wichmann JL, Schoepf UJ, Lu GM and Zhang LJ wrote the paper.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, No. 305 Zhongshan East Road, Nanjing, 210002, Jiangsu Province, China

    Hui Juan Chen, Gang Zheng, Guang Ming Lu & Long Jiang Zhang

  2. College of Civil Aviation, Nanjing University of Aeronautics and Astronautics, Nanjing, Jiangsu, 210016, China

    Gang Zheng

  3. Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29401, USA

    Julian L. Wichmann & U. Joseph Schoepf

  4. Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany

    Julian L. Wichmann

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  1. Hui Juan Chen
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  2. Gang Zheng
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  3. Julian L. Wichmann
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  4. U. Joseph Schoepf
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  5. Guang Ming Lu
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  6. Long Jiang Zhang
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Correspondence to Long Jiang Zhang.

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Chen, H.J., Zheng, G., Wichmann, J.L. et al. The brain following transjugular intrahepatic portosystemic shunt: the perspective from neuroimaging. Metab Brain Dis 30, 1331–1341 (2015). https://doi.org/10.1007/s11011-015-9735-4

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