Hepatic encephalopathy on magnetic resonance imaging and its uncertain differential diagnoses: a narrative review
1
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Hepatic encephalopathy (HE) is a severe neuropsychiatric abnormality in patients with either acute or chronic liver failure. Typical brain magnetic resonance imaging findings of HE are bilateral basal ganglia high signal intensities due to manganese deposition in chronic liver disease and hyperintensity in T2, fluid-attenuated inversion recovery, or diffusion-weighted imaging (DWI) with hemispheric white matter changes including the corticospinal tract. Low values on apparent diffusion coefficient mapping of the affected area on DWI, indicating cytotoxic edema, can be observed in acute HE. However, neuropsychological impairment in HE ranges from mild deficits in psychomotor abilities affecting quality of life to stupor or coma with higher grades of hepatic dysfunction. In particular, the long-lasting compensatory mechanisms for the altered metabolism in chronic liver disease make HE imaging results variable. Therefore, the clinical relevance of imaging findings is uncertain and differentiating HE from other metabolic diseases can be difficult. The recent introduction of concepts such as “acute-on-chronic liver failure (ACLF),” a new clinical entity, has led to a change in the clinical view of HE. Accordingly, there is a need to establish a corresponding concept in the field of neuroimaging diagnosis. Herein, we review HE from a historical and etiological perspective to increase understanding of brain imaging and help establish an imaging approach for advanced new concepts such as ACLF. The purpose of this manuscript is to provide an understanding of HE by reviewing neuroimaging findings based on pathological and clinical concepts of HE, thereby assisting in neuroimaging interpretation.
Abstract
Hepatic encephalopathy (HE) is a severe neuropsychiatric abnormality in patients with either acute or chronic liver failure. Typical brain magnetic resonance imaging findings of HE are bilateral basal ganglia high signal intensities due to manganese deposition in chronic liver disease and hyperintensity in T2, fluid-attenuated inversion recovery, or diffusion-weighted imaging (DWI) with hemispheric white matter changes including the corticospinal tract. Low values on apparent diffusion coefficient mapping of the affected area on DWI, indicating cytotoxic edema, can be observed in acute HE. However, neuropsychological impairment in HE ranges from mild deficits in psychomotor abilities affecting quality of life to stupor or coma with higher grades of hepatic dysfunction. In particular, the long-lasting compensatory mechanisms for the altered metabolism in chronic liver disease make HE imaging results variable. Therefore, the clinical relevance of imaging findings is uncertain and differentiating HE from other metabolic diseases can be difficult. The recent introduction of concepts such as “acute-on-chronic liver failure (ACLF),” a new clinical entity, has led to a change in the clinical view of HE. Accordingly, there is a need to establish a corresponding concept in the field of neuroimaging diagnosis. Herein, we review HE from a historical and etiological perspective to increase understanding of brain imaging and help establish an imaging approach for advanced new concepts such as ACLF. The purpose of this manuscript is to provide an understanding of HE by reviewing neuroimaging findings based on pathological and clinical concepts of HE, thereby assisting in neuroimaging interpretation.
참고문헌 (45)
- Hazell AS, "Hepatic encephalopathy : an update of pathophysiologic mechanisms", Proc Soc Exp Biol Med, 222, pp.99~112 (1999)
- Sherlock S, "Hepatic encephalopathy", Br J Hosp Med, 17, pp.144~146 (1977)
- Inoue E, "Portal-systemic encephalopathy : presence of basal ganglia lesions with high signal intensity on MR images", Radiology, 179, pp.551~555 (1991)
- Syh HW, "An image analysis on MR imaging of the brain for hepatic encephalopathy", Biomed Sci Instrum, 27, pp.29~33 (1991)
- Zeneroli ML, "Globus pallidus alterations and brain atrophy in liver cirrhosis patients with encephalopathy : an MR imaging study", Magn Reson Imaging, 9, pp.295~302 (1991)
- Zerón HM, "Blood manganese levels in patients with hepatic encephalopathy", J Trace Elem Med Biol, 25, pp.225~229 (2011)
- Pujol A, "Hyperintense globus pallidus on T1-weighted MRI in cirrhotic patients is associated with severity of liver failure", Neurology, 43, pp.65~69 (1993)
- Krieger D, "Manganese and chronic hepatic encephalopathy", Lancet, 346, pp.270~274 (1995)
- 이동현, "The Pallidal Index in Patients with Acute-on-Chronic Liver Disease: Is It a Predictor of Severe Hepatic Encephalopathy?", Investigative Magnetic Resonance Imaging, 21(3), pp.125~130 (2017), 대한자기공명의과학회[DOI]
- Rovira A, "Normalization of T2 signal abnormalities in hemispheric white matter with liver transplant", Neurology, 59, pp.335~341 (2002)
- Gabriel S, "Marchiafava-Bignami syndrome : extrapontine myelinolysis in chronic alcoholism", Nervenarzt, 70, pp.349~356 (1999)
- Alvarez-Leal M, "Leukocyte arylsulfatase A activity in patients with alcohol-related cirrhosis", Am J Hum Biol, 13, pp.297~300 (2001)
- Rovira A, "MR imaging findings in hepatic encephalopathy", AJNR Am J Neuroradiol, 29, pp.1612~1621 (2008)
- Arnold SM, "Acute hepatic encephalopathy with diffuse cortical lesions", Neuroradiology, 43, pp.551~554 (2001)
- Matsusue E, "Cerebral cortical and white matter lesions in chronic hepatic encephalopathy : MR-pathologic correlations", AJNR Am J Neuroradiol, 26, pp.347~351 (2005)
- Kreis R, "Metabolic disorders of the brain in chronic hepatic encephalopathy detected with H-1 MR spectroscopy", Radiology, 182, pp.19~27 (1992)
- Binesh N, "Hepatic encephalopathy : a neurochemical, neuroanatomical, and neuropsychological study", J Appl Clin Med Phys, 7, pp.86~96 (2006)
- Binesh N, "Adding another spectral dimension to 1H magnetic resonance spectroscopy of hepatic encephalopathy", J Magn Reson Imaging, 21, pp.398~405 (2005)
- Taylor-Robinson SD, "MR imaging and spectroscopy of the basal ganglia in chronic liver disease : correlation of T1-weighted contrast measurements with abnormalities in proton and phosphorus-31 MR spectra", Metab Brain Dis, 11, pp.249~268 (1996)
- Butterworth R, "Neuronal cell death in hepatic encephalopathy", Metab Brain Dis, 22, pp.309~320 (2007)
- Norenberg MD, "Astrocyte swelling in liver failure : role of glutamine and benzodiazepines", Acta Neurochir Suppl(Wien), 60, pp.24~27 (1994)
- Kril JJ, "Diencephalic and cerebellar pathology in alcoholic and nonalcoholic patients with end-stage liver disease", Hepatology, 26, pp.837~841 (1997)
- Kreis R, "Localized 1H NMR spectroscopy in patients with chronic hepatic encephalopathy : analysis of changes in cerebral glutamine, choline and inositols", NMR Biomed, 4, pp.109~116 (1991)
- Romero-Gómez M, "Hepatic encephalopathy in patients with acute decompensation of cirrhosis and acute-on-chronic liver failure", J Hepatol, 62, pp.437~447 (2015)
- Victor M, "The acquired(non-Wilsonian)type of chronic hepatocerebral degeneration", Medicine(Baltimore), 44, pp.345~396 (1965)
- Sobel RA, "Glial fibrillary acidic protein in hepatic encephalopathy : an immunohistochemical study", J Neuropathol Exp Neurol, 40, pp.625~632 (1981)
- Butterworth RF, "Ammonia : key factor in the pathogenesis of hepatic encephalopathy", Neurochem Pathol, 6, pp.1~12 (1987)
- Kato M, "Electron microscopic study of brain capillaries in cerebral edema from fulminant hepatic failure", Hepatology, 15, pp.1060~1066 (1992)
- Desjardins P, "Alterations in expression of genes coding for key astrocytic proteins in acute liver failure", J Neurosci Res, 66, pp.967~971 (2001)
- Rama Rao KV, "Suppression of ammonia-induced astrocyte swelling by cyclosporin A", J Neurosci Res, 74, pp.891~897 (2003)
- Ferenci P, "Hepatic encephalopathy--definition, nomenclature, diagnosis, and quantification : final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998", Hepatology, 35, pp.716~721 (2002)
- Ridola L, "Hepatic encephalopathy : diagnosis and management", J Transl Int Med, 8, pp.210~219 (2020)
- Häussinger D, "Pathogenesis of hepatic encephalopathy", J Gastroenterol Hepatol, 17(Suppl 3), pp.S256~9 (2002)
- Jalan R, "Acute-on-chronic liver failure : pathophysiological basis of therapeutic options", Blood Purif, 20, pp.252~261 (2002)
- Moreau R, "Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis", Gastroenterology, 144, pp.1426~1437 (2013)
- Arroyo V, "Acute-on-chronic liver failure", N Engl J Med, 382, pp.2137~2145 (2020)
- Kleinschmidt-DeMasters BK, "Overlapping features of extrapontine myelinolysis and acquired chronic(non-Wilsonian)hepatocerebral degeneration", Acta Neuropathol, 112, pp.605~616 (2006)
- Adams RD, "Central pontine myelinolysis : a hitherto undescribed disease occurring in alcoholic and malnourished patients", AMA Arch Neurol Psychiatry, 81, pp.154~172 (1959)
- Ho VB, "Resolving MR features in osmotic myelinolysis(central pontine and extrapontine myelinolysis)", AJNR Am J Neuroradiol, 14, pp.163~167 (1993)
- Gocht A, "Central pontine and extrapontine myelinolysis : a report of 58 cases", Clin Neuropathol, 6, pp.262~270 (1987)
- Kim E, "MR imaging of metronidazole-induced encephalopathy : lesion distribution and diffusion-weighted imaging findings", AJNR Am J Neuroradiol, 28, pp.1652~1658 (2007)
- Behzadi F, "Bilateral hypertrophic olivary degeneration following brainstem insult : a retrospective review and examination of causative pathology", Neurosci Insights, 16, pp.26331055211007445~ (2021)
- Jang S, "Enterovirus 71-related encephalomyelitis : usual and unusual magnetic resonance imaging findings", Neuroradiology, 54, pp.239~245 (2012)
- Di Rocco M, "MRI in acute intermittent maple syrup urine disease", Neurology, 63, pp.1078~ (2004)
- Geyer HL, "Methyl bromide intoxication causes reversible symmetric brainstem and cerebellar MRI lesions", Neurology, 64, pp.1279~1281 (2005)