Editors' note: Meta-analysis of magnetic resonance spectroscopy in the diagnosis of hepatic encephalopathy

Abstract

In their systematic review and meta-analysis of magnetic resonance spectroscopy (MRS) findings associated with hepatic encephalopathy (HE) due to cirrhosis, Zeng et al. observed a statistically significant increase in glutamine/glutamate metabolites with a decrease in myo-inositol and choline concentrations throughout the parietal, occipital, and basal ganglia regions among patients with HE vs those without HE. Of these metabolites, glutamine/glutamate presence in the parietal lobe was the most robust predictor of HE. In response to these findings, Dr. Gupta expresses concern as to the utility of advanced MRS imaging, given that HE remains a clinical diagnosis. The authors respond that MRS may be useful for earlier identification of mild or subclinical HE, which may lead to earlier, targeted treatment in patients at risk for later decompensation. In their systematic review and meta-analysis of magnetic resonance spectroscopy (MRS) findings associated with hepatic encephalopathy (HE) due to cirrhosis, Zeng et al. observed a statistically significant increase in glutamine/glutamate metabolites with a decrease in myo-inositol and choline concentrations throughout the parietal, occipital, and basal ganglia regions among patients with HE vs those without HE. Of these metabolites, glutamine/glutamate presence in the parietal lobe was the most robust predictor of HE. In response to these findings, Dr. Gupta expresses concern as to the utility of advanced MRS imaging, given that HE remains a clinical diagnosis. The authors respond that MRS may be useful for earlier identification of mild or subclinical HE, which may lead to earlier, targeted treatment in patients at risk for later decompensation.