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(Radiology. 2000;216:683-691.)
© RSNA, 2000

Neuroradiology

MR Imaging and 1H Spectroscopy of Brain Metabolites in Hepatic Encephalopathy: Time-Course of Renormalization after Liver Transplantation1

Thomas Naegele, MD, Wolfgang Grodd, MD, Richard Viebahn, MD, Uwe Seeger, PhD, Uwe Klose, PhD, Dietmar Seitz, MD, Stephan Kaiser, MD, Irina Mader, MD, Jochen Mayer, MD, Werner Lauchart, MD, Michael Gregor, MD and Karsten Voigt, MD

1 From the Depts of Neuroradiology (T.N., W.G., U.S., U.K., D.S., I.M., J.M., K.V.), General Surgery (R.V., W.L.), and Gastroenterology and Hepatology (S.K., M.G.), Univ of Tübingen, Hoppe-Seyler Str. 3, 72076 Tübingen, Germany. Received Apr 26, 1999; revision requested Jul 12; final revision received Jan 24, 2000; accepted Mar 7. Supported in part by the Deutsche Forschungsgemeinschaft (DFG: KL 1093/1-1). U.K. supported by a grant from the Federal Ministry of Education Science, Research and Technology (Foe. 01KS9602). T.N. supported by the Interdisciplinary Clinical Research Center (IKFZ), Tübingen. Address correspondence to T.N. (e-mail: thomas.naegele@med.uni-tuebingen.de).

PURPOSE: To evaluate changes in hydrogen 1 magnetic resonance (MR) spectroscopic findings in overt or subclinical hepatic encephalopathy (HE) after liver transplantation and to compare these changes with clinical outcomes and basal ganglia high signal intensity (BGH).

MATERIALS AND METHODS: Twenty-two patients scheduled for liver transplantation and 17 healthy control subjects were examined with 1H MR spectroscopy and standard nonenhanced MR imaging. Eight patients underwent complete MR imaging and 1H spectroscopic examinations before liver transplantation and at 3–4-week, 12–28-week, and 10–12-month follow-up after liver transplantation.

RESULTS: Before liver transplantation, typical 1H spectroscopic changes—decreased myo-inositol (mI)/creatine (Cr) and choline (Cho)/Cr ratios and an elevated glutamine and glutamate (Glx)/Cr ratio—were found in 21 patients. Eighteen patients had BGH at T1-weighted imaging. Three to 7 months after liver transplantation, the mI/Cr and Glx/Cr ratios were within the normal range in five of eight and eight of eight patients, respectively, without any residual signs of subclinical or overt HE; however, at MR imaging, seven patients still had BGH.

CONCLUSION: After successful liver transplantation, renormalization of HE-specific brain metabolite changes is detected at 1H spectroscopy and precedes the disappearance of BGH. The neuropsychologic signs of subclinical or overt HE follow the changes seen at 1H spectroscopy rather than those seen at MR imaging.

Index terms: Brain, diseases, 10.59, 10.891 • Brain, metabolism • Brain, MR, 10.121411, 10.121416, 10.12145 • Liver, cirrhosis, 761.79 • Liver transplantation, 761.45, 761.79 • Magnetic resonance (MR), spectroscopy, 10.12145, 18.12145




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