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A longitudinal study of patients with cirrhosis treated with L-ornithine L-aspartate, examined with magnetization transfer, diffusion-weighted imaging and magnetic resonance spectroscopy

Lookup NU author(s): Dr Brian Saxby

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Abstract

The presence of overt hepatic encephalopathy (HE) is associated with structural, metabolic and functional changes in the brain discernible by use of a variety of magnetic resonance (MR) techniques. The changes in patients with minimal HE are less well documented. Twenty-two patients with well-compensated cirrhosis, seven of whom had minimal HE, were examined with cerebral 3 Tesla MR techniques, including T-1- and T-2-weighted, magnetization transfer and diffusion-weighted imaging and proton magnetic resonance spectroscopy sequences. Studies were repeated after a 4-week course of oral L-ornithine L-aspartate (LOLA). Results were compared with data obtained from 22 aged-matched healthy controls. There was no difference in mean total brain volume between patients and controls at baseline. Mean cerebral magnetization transfer ratios were significantly reduced in the globus pallidus and thalamus in the patients with cirrhosis irrespective of neuropsychiatric status; the mean ratio was significantly reduced in the frontal white matter in patients with minimal HE compared with healthy controls but not when compared with their unimpaired counterparts. There were no significant differences in either the median apparent diffusion coefficients or the mean fractional anisotropy, calculated from the diffusion-weighted imaging, or in the mean basal ganglia metabolite ratios between patients and controls. Psychometric performance improved in 50 % of patients with minimal HE following LOLA, but no significant changes were observed in brain volumes, cerebral magnetization transfer ratios, the diffusion weighted imaging variables or the cerebral metabolite ratios. MR variables, as applied in this study, do not identify patients with minimal HE, nor do they reflect changes in psychometric performance following LOLA.


Publication metadata

Author(s): Grover VPB, McPhail MJW, Wylezinska-Arridge M, Crossey MME, Fitzpatrick JA, Southern L, Saxby BK, Cook NA, Cox IJ, Waldman AD, Dhanjal NS, Bak-Bol A, Williams R, Morgan MY, Taylor-Robinson SD

Publication type: Article

Publication status: Published

Journal: Metabolic Brain Disease

Year: 2017

Volume: 32

Issue: 1

Pages: 77-86

Print publication date: 01/02/2017

Online publication date: 03/08/2016

Acceptance date: 19/07/2016

Date deposited: 23/02/2017

ISSN (print): 0885-7490

ISSN (electronic): 1573-7365

Publisher: Springer

URL: http://dx.doi.org/10.1007/s11011-016-9881-3

DOI: 10.1007/s11011-016-9881-3


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