Skip to main content
SpringerLink
Log in

Chemical shift magnetic resonance spectroscopy of cingulate grey matter in patients with minimal hepatic encephalopathy

  • Diagnostic Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Abstract

Minimal hepatic encephalopathy (MHE) is frequently diagnosed in patients with liver cirrhosis who do not show overt clinical cirrhosis-associated neurological deficits. This condition manifests primarily with visuo-motor and attention deficits. We studied the association between visuo-motor deficits and magnetic resonance spectroscopic parameters in cingulate grey matter and white matter of centrum semiovale in patients with liver cirrhosis. The data revealed an increase in the glutamate–glutamine/creatine ratio and a decrease in choline/creatine and inositol/creatine ratios in patients with liver cirrhosis. The analysis of the data showed that cirrhosis-associated deterioration of the visuo-motor function significantly correlates with a decrease in the choline/creatine ratio and an increase in N-acetylaspartate/choline in cingulate grey matter but not in the neighbouring white matter. Furthermore, the increase in the glutamate–glutamine/creatine ratio correlated significantly with the increase in the N-acetylaspartate/creatine ratio. These data suggest an association between altered choline, glutamate-glutamine and NAA metabolism in cingulate grey matter and symptoms of MHE, and underline the importance of differentiation between grey and white matter in magnetic resonance spectroscopic studies on patients with cirrhosis-associated brain dysfunction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2A–D
Fig. 3

Similar content being viewed by others

References

  1. Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT (2002) Hepatic encephalopathy—definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology 35:716–721

    Google Scholar 

  2. Lockwood AH (1998) Early detection and treatment of hepatic encephalopathy Curr Opin Neurol 11:663–666

    Google Scholar 

  3. Butterworth RF (2002) Pathophysiology of hepatic encephalopathy: a new look at ammonia. Metab Brain Dis 17:221–227

    Google Scholar 

  4. Weissenborn K, Heidenreich S, Giewekemeyer K, Ruckert N, Hecker H (2003) Memory function in early hepatic encephalopathy. J Hepatol 39: 320–325

    Google Scholar 

  5. Weissenborn K, Heidenreich S, Ennen J, Ruckert N, Hecker H (2001) Attention deficits in minimal hepatic encephalopathy. Metab Brain Dis 16: 13–19

    Google Scholar 

  6. Weissenborn K, Ennen JC, Schomerus H, Ruckert N, Hecker H (2001) Neuropsychological characterization of hepatic encephalopathy. J Hepatol 34:768–773

    Google Scholar 

  7. Groeneweg M, Moerland W, Quero JC, Hop WC, Krabbe PF, Schalm SW (2000) Screening of subclinical hepatic encephalopathy. J Hepatol 32: 748–753

    Google Scholar 

  8. Schomerus H, Hamster W (1998) Neuropsychological aspects of portal-systemic encephalopathy. Metab Brain Dis 13:361–377

    Google Scholar 

  9. Ross BD, Danielsen ER, Bluml S (1996) Proton magnetic resonance spectroscopy: the new gold standard for diagnosis of clinical and subclinical hepatic encephalopathy? Dig Dis 14(Suppl 1):30–39

    Google Scholar 

  10. Naegele T, Grodd W, Viebahn R, Seeger U, Klose U, Seitz D, Kaiser S, Mader I, Mayer J, Lauchart W, Gregor M, Voigt K (2000) MR imaging and (1)H spectroscopy of brain metabolites in hepatic encephalopathy: time-course of renormalization after liver transplantation. Radiology 216:683–691

    Google Scholar 

  11. Kreis R, Ross BD, Farrow NA, Ackerman Z (1992) Metabolic disorders of the brain in chronic hepatic encephalopathy detected with H-1 MR-spectroscopy. Radiology 182:19–27

    Google Scholar 

  12. Ross BD, Jacobson S, Villamil F, Korula J, Kreis R, Ernst T, Shonk T, Moats RA (1994) Subclinical hepatic encephalopathy: proton MR-spectroscopic abnormalities. Radiology 193:457–463

    Google Scholar 

  13. Jalan R, Olde Damink SW, Hayes PC, Wardlaw JM (1999) Diagnosis of hepatic encephalopathy: will in vivo proton MRS play a role? Hepatology 29:1605–1607

    Google Scholar 

  14. Masur H (2000) Skalen und Scores in der Neurologie. Georg Thieme Verlag, Stuttgart, p 497

    Google Scholar 

  15. Lezak DL (1983) Neuropsychological Assessment. Oxford University Press, New York

    Google Scholar 

  16. Spreen O, Strauss E (1991) A Compendium of Neuropsychological Tests. Oxford University Press, New York

    Google Scholar 

  17. Schaaf A, Kessler J, Grond M, Fink GR (1992) Memo-Test. Beltz Test GmbH, Göttingen

    Google Scholar 

  18. Lehrl S (1999) Mehrfach-Wortschatz-Intelligenztest. Spitta Verlag, Berlingen

    Google Scholar 

  19. Knight-Scott J, Haley AP, Rossmiller SR, Farace E, Mai VM, Christopher JM, Manning CA, Simnad VI, Siragy HM (2003) Molality as a unit of measure for expressing 1 H MRS brain metabolite concentrations in vivo. Magn Reson Imaging 21:787–797

    Google Scholar 

  20. Frahm J, Bruhn H, Gyngell ML, Merboldt KD, Hanicke W, Sauter R (1989) Localized high-resolution proton NMR spectroscopy using stimulated echoes: initial applications to human brain in vivo. Magn Reson Med 9:79–93

    CAS  PubMed  Google Scholar 

  21. Michaelis T, Merboldt KD, Hanicke W, Gyngell ML, Bruhn H, Frahm J (1991) On the identification of cerebral metabolites in localized 1 H NMR spectra of human brain in vivo. NMR Biomed 4:90–98

    CAS  PubMed  Google Scholar 

  22. Geissler A, Lock G, Frund R, Held P, Hollerbach S, Andus T, Scholmerich J, Feuerbach S, Holstege A (1997) Cerebral abnormalities in patients with cirrhosis detected by proton magnetic resonance spectroscopy and magnetic resonance imaging. Hepatology 25:48–54

    Google Scholar 

  23. Taylor-Robinson SD, Sargentoni J, Marcus CD, Morgan MY, Bryant DJ (1994) Regional variations in cerebral proton spectroscopy in patients with chronic hepatic encephalopathy. Metab Brain Dis 9:347–359

    Google Scholar 

  24. Cordoba J, Sanpedro F, Alonso J, Rovira A (2002) 1H magnetic resonance in the study of hepatic encephalopathy in humans. Metab Brain Dis 17:415–429

    Google Scholar 

  25. Boesch SM, Schocke M, Burk K, Hollosi P, Fornai F, Aichner FT, Poewe W, Felber S (2001) Proton magnetic resonance spectroscopic imaging reveals differences in spinocerebellar ataxia types 2 and 6. J Magn Reson Imaging 13:553–559

    Google Scholar 

  26. Kantarci K, Reynolds G, Petersen RC, Boeve BF, Knopman DS, Edland SD, Smith GE, Ivnik RJ, Tangalos EG, Jack CR, Jr. (2003) Proton MR-spectroscopy in mild cognitive impairment and Alzheimer disease: comparison of 1.5 and 3 T. AJNR Am J Neuroradiol 24:843–849

    Google Scholar 

  27. Del Sole A, Gambini A, Falini A, Lecchi M, Lucignani G (2002) In vivo neurochemistry with emission tomography and magnetic resonance spectroscopy: clinical applications. Eur Radiol 12:2582–2599

    Google Scholar 

  28. Schocke MFH, Berger T, Felber SR, Wolf C, Deisenhammer F, Kremser C, Seppi K, Aichner FT (2003) Serial contrast-enhanced magnetic resonance imaging and spectroscopic imaging of acute multiple sclerosis lesions under high-dose methylprednisolone therapy. Neuroimage Oct 20:1253–1263

    Google Scholar 

  29. Mechtcheriakov S, Graziadei IW, Mattedi M, Bodner T, Kugener A, Hinterhuber HH, Marksteiner J, Vogel W (2004) Incomplete improvement of visuo-motor deficits in patients with minimal hepatic encephalopathy after liver transplantation. Liver Trans 10:77–83

    Google Scholar 

  30. Pelletier D, Nelson SJ, Grenier D, Lu Y, Genain C, Goodkin DE (2002) 3-D echo planar (1)HMRS imaging in MS: metabolite comparison from supratentorial vs central brain. Magn Reson Imaging 20:599–606

    Google Scholar 

  31. Cordoba J, Hinojosa C, Sampedro F, Alonso J, Rovira A, Quiroga S, Esteban R, Guardia J (2001) Usefulness of magnetic resonance spectroscopy for diagnosis of hepatic encephalopathy in a patient with relapsing confusional syndrome. Dig Dis Sci 46:2451–2455

    Google Scholar 

  32. Catafau AM, Kulisevsky J, Berna L, Pujol J, Martin JC, Otermin P, Balanzo J, Carrio I (2000) Relationship between cerebral perfusion in frontal-limbic-basal ganglia circuits and neuropsychologic impairment in patients with subclinical hepatic encephalopathy. J Nucl Med 41: 405–410

    Google Scholar 

  33. Clarke CE, Lowry M (2001) Systematic review of proton magnetic resonance spectroscopy of the striatum in parkinsonian syndromes. Eur J Neurol 8:573–577

    Google Scholar 

  34. Monfort P, Munoz MD, ElAyadi A, Kosenko E, Felipo V (2002) Effects of hyperammonemia and liver failure on glutamatergic neurotransmission. Metab Brain Dis 17:237–250

    Google Scholar 

  35. Gehl LM, Saab OH, Bzdega T, Wroblewska B, Neale JH (2004) Biosynthesis of NAAG by an enzyme-mediated process in rat central nervous system neurons and glia. J Neurochem 90:989–997

    Google Scholar 

  36. Neale JH, Bzdega T, Wroblewska B (2000) N-Acetylaspartylglutamate: the most abundant peptide neurotransmitter in the mammalian central nervous system. J Neurochem 75:443–452

    Google Scholar 

  37. Pouwels PJ, Frahm J (1997) Differential distribution of NAA and NAAG in human brain as determined by quantitative localized proton MRS. NMR Biomed 10:73–78

    Google Scholar 

  38. Tyson RL, Sutherland GR (1998) Labeling of N-acetylaspartate and N-acetylaspartylglutamate in rat neocortex, hippocampus and cerebellum from [1-13C]glucose. Neurosci Lett 251:181–184

    Google Scholar 

  39. Tkac I, Dirk Keene, Walter C.Low, Rolf Gruetter, Pierre-Gilles Henry (2004) Highly resolved in vivo 1 H NMR spectroscopy of the mouse brain at 9.4 T. Magn Reson Med 52(3):478–484

    Google Scholar 

  40. Rovira A, Grive E, Pedraza S, Rovira A, Alonso J (2001) Magnetization transfer ratio values and proton MR spectroscopy of normal-appearing cerebral white matter in patients with liver cirrhosis. AJNR Am J Neuroradiol 22:1137–1142

    Google Scholar 

Download references

Acknowledgements

We are thankful to Dr. G. Kemmler for support in the statistical analysis and to Mrs. Simone Auffinger and Dr. Th. Bodner for their technical assistance. The stipend for M. Mattedi was sponsored by Dr. Kolassa + Merz (Vienna).

Author information

Authors and Affiliations

  1. Department of General Psychiatry, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria

    Sergei Mechtcheriakov, André Kugener, Michael Mattedi, Hartmann Hinterhuber & Josef Marksteiner

  2. Department of Radiology I, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria

    Michael Schocke

  3. Department of Gastroenterology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria

    Ivo W. Graziadei & Wolfgang Vogel

Authors
  1. Sergei Mechtcheriakov
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Schocke
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. André Kugener
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ivo W. Graziadei
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael Mattedi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hartmann Hinterhuber
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Wolfgang Vogel
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Josef Marksteiner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sergei Mechtcheriakov.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mechtcheriakov, S., Schocke, M., Kugener, A. et al. Chemical shift magnetic resonance spectroscopy of cingulate grey matter in patients with minimal hepatic encephalopathy. Neuroradiology 47, 27–34 (2005). https://doi.org/10.1007/s00234-004-1298-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-004-1298-8

Keywords

Search

Navigation