Abstract
BackgroundLittle is known about how spontaneous brain activity progresses from non-hepatic encephalopathy (non-HE) to minimal HE (MHE). The purpose of this study was to evaluate the evolution pattern of spontaneous brain activities in cirrhotic patients using resting-state fMRI with a regional homogeneity (ReHo) method.Methodology/Principal FindingsResting-state fMRI data were acquired in 47 cirrhotic patients (minimal HE [MHE], n = 20, and non-HE, n = 27) and 25 age-and sex-matched healthy controls. The Kendall’s coefficient of concordance (KCC) was used to measure the regional homogeneity. The regional homogeneity maps were compared with ANOVA tests among MHE, non-HE, and healthy control groups and t-tests between each pair in a voxel-wise way. Correlation analyses were performed to explore the relationships between regional ReHo values and Child-Pugh scores, number connection test type A (NCT-A), digit symbol test (DST) scores, venous blood ammonia levels. Compared with healthy controls, both MHE and non-HE patients showed decreased ReHo in the bilateral frontal, parietal and temporal lobes and increased ReHo in the bilateral caudate. Compared with the non-HE, MHE patients showed decreased ReHo in the bilateral precuneus, cuneus and supplementary motor area (SMA). The NCT-A of cirrhotic patients negatively correlated with ReHo values in the precuneus, cuneus and lingual gyrus. DST scores positively correlated with ReHo values in the cuneus, precuneus and lingual gyrus, and negatively correlated with ReHo values in the bilateral caudate (P<0.05, AlphaSim corrected).Conclusions/SignificanceDiffused abnormal homogeneity of baseline brain activity was nonspecific for MHE, and only the progressively decreased ReHo in the SMA and the cuneus, especially for the latter, might be associated with the development of MHE. The ReHo analysis may be potentially valuable for detecting the development from non-HE to MHE.
Highlights
Minimal hepatic encephalopathy (MHE) refers to a subgroup of cirrhotic patients without clinical overt hepatic encephalopathy (OHE) symptoms but with abnormalities in brain metabolism, motor and neuro-cognitive functions [1,2]
We found diffused decreased regional homogeneity (ReHo) values in the cortical regions, and increased ReHo in the bilateral caudate in both minimal HE (MHE) and non-HE patients, indicating these changes are not specific for MHE
Patients with MHE showed more widely spread decreased ReHo values in some brain cortices than non-HE patients, suggesting further impairment with the development from non-HE to MHE. These ReHo values in the most identified brain regions correlated with neuropsychological impairments in cirrhotic patients
Summary
Minimal hepatic encephalopathy (MHE) refers to a subgroup of cirrhotic patients without clinical overt hepatic encephalopathy (OHE) symptoms but with abnormalities in brain metabolism, motor and neuro-cognitive functions [1,2]. Several task-related [8,9,10] and resting-state fMRI (rsfMRI) [11,12] studies have demonstrated functional impairments in MHE or OHE patients and negative correlations of these brain abnormalities with clinical marks of HE, such as venous blood ammonia levels. The purpose of this study was to evaluate the evolution pattern of spontaneous brain activities in cirrhotic patients using resting-state fMRI with a regional homogeneity (ReHo) method
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