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Serum proinflammatory cytokines correlate with diffusion tensor imaging derived metrics and 1H-MR spectroscopy in patients with acute liver failure

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Abstract

Hyperammonemia and inflammation are major contributing factors in the development of cerebral edema (CE) in acute liver failure (ALF). Aim of this study was to look for the relationship between proinflammatory cytokines with diffusion tensor imaging (DTI) derived metrics and 1H-MR spectroscopy (1H-MRS) derived Glutamate/Glutamine (Glx). Fourteen patients with ALF and 14 age/sex matched controls were included in this study. All subjects had undergone clinical, biochemical, MR imaging and 1H-MRS studies. Serum proinflammatory cytokines (IL-6 and TNF-α), blood ammonia level and Glx were computed for independent t-test and Pearson correlation. Serum proinflammatory cytokines, blood ammonia level and brain Glx were significantly increased in ALF patients as compared to controls. Blood ammonia level and Glx showed significant positive correlation with proinflammatory cytokines. Spectroscopy voxel derived spherical anisotropy (CS) showed positive correlation with Glx while mean diffusivity (MD) showed negative correlation. Proinflammatory cytokines showed positive correlation with CS and negative correlation with MD in various brain regions including spectroscopy voxel. Significant correlation of Glx, CS and MD with proinflammatory cytokines suggests that both DTI derived metrics and 1H-MRS measure the synergistic effect of hyperammonemia and proinflammatory cytokines and may be used as non-invasive tools for understanding the pathogenesis of CE in ALF.

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Abbreviations

ALF:

acute liver failure

CE:

cerebral edema

HE:

hepatic encephalopathy

Glx:

Glutamate/Glutamine

IL-6:

interleukin-6

TNF-α:

tumor necrosis factor-α

1H-MRS:

1H magnetic resonance spectroscopy

DTI:

diffusion tensor imaging

MD:

mean diffusivity

CS:

spherical anisotropy

MRI:

magnetic resonance imaging

TR:

repetition time

TE:

echo time

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Acknowledgments

This study was supported by Indian Council of Medical Research (grant No.5/9/62/2008-RHN), New Delhi, India. Santosh Kumar Yadav gratefully acknowledge the financial assistance from the Indian Council of Medical Research, New Delhi, India.

Conflict of interest

There is no conflict of interest regarding this manuscript.

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Authors and Affiliations

  1. Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India

    Rakesh Kumar Gupta & Santosh Kumar Yadav

  2. Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India

    Murali Rangan & Vivek Anand Saraswat

  3. Department of Mathematics and Statistics, Indian Institute of Technology, Kanpur, India

    Ram Kishore Singh Rathore

  4. Department of Radiological Sciences, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA

    Michael Albert Thomas

  5. Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India

    Kashi Nath Prasad

  6. Department of Biostatistics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India

    Chandra Mohan Pandey

  7. Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, UP, India, 226014

    Rakesh Kumar Gupta

Authors
  1. Rakesh Kumar Gupta
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  2. Santosh Kumar Yadav
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  4. Ram Kishore Singh Rathore
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  5. Michael Albert Thomas
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  8. Vivek Anand Saraswat
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Correspondence to Rakesh Kumar Gupta.

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Gupta, R.K., Yadav, S.K., Rangan, M. et al. Serum proinflammatory cytokines correlate with diffusion tensor imaging derived metrics and 1H-MR spectroscopy in patients with acute liver failure. Metab Brain Dis 25, 355–361 (2010). https://doi.org/10.1007/s11011-010-9206-x

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  • DOI: https://doi.org/10.1007/s11011-010-9206-x

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