Diffusion-Weighted Imaging in Minimal Hepatic Encephalopathy Using Mono-, Bi-, and Stretched Exponential Models

Abstract

Background: Currently, there is no gold standard for diagnosing minimal hepatic encephalopathy (MHE). Diffusion-weighted imaging (DWI) can non-invasively evaluate changes in brain volume and damage to brain function. Objectives: The current study aims to evaluate changes in cerebral blood flow and brain function as predictors of MHE using DWI. Patients and Methods: Participants from October 2016 to October 2021 were scanned using a 3.0T superconductive MR machine (Discovery MR750, GE Medical Systems). Intravoxel incoherent motion DWI (IVIM-DWI) images of 30 patients with MHE and 30 controls were analyzed in a retrospective case-control study. The parameters of mono-, bi-, and stretched exponential models of the regions of interest, delineated from cerebral perfusion pseudo-color maps, were measured. The significance of the differences in parameter values between the groups was assessed using an independent t-test. Furthermore, the receiver operating characteristic curve was used to analyze the predictive efficiency of each parameter for MHE. Results: Compared to the control group, the distributed diffusion coefficient (DDC) of the bilateral frontal lobe, temporal lobe, occipital lobe, parietal lobe, cingulate gyrus, and thalamus in the MHE group was statistically different (P < 0.05). The pseudo-diffusion coefficient (D*) and DDC demonstrated good diagnostic efficacy for MHE. D* had the highest area under the curve (AUC) in the bilateral parietal lobe, bilateral cingulate gyrus, and left occipital lobe. In contrast, DDC had the highest AUC in the right occipital and bilateral temporal lobes. Conclusion: Intravoxel incoherent motion DWI is an imaging method that can detect MHE. In addition, D* and DDC are better diagnostic parameters for screening MHE. Intravoxel incoherent motion DWI will be helpful in uncovering deeper intrinsic pathophysiological mechanisms and improving predictive efficiency.