Abstract
Portal-systemic encephalopathy (PSE) is classified as type B hepatic encephalopathy. Portal-systemic shunting rather than liver dysfunction is the main cause of PSE in chronic hepatic schistosomiasis japonicum (HSJ) patients. Owing to lack of detectable evidence of intrinsic liver disease, chronic HSJ patients with PSE are frequently clinically undetected or misdiagnosed, especially chronic HSJ patients with covert PSE (subclinical encephalopathy). In this study, we investigated whether magnetic resonance spectroscopy (MRS) could be a useful tool for diagnosing PSE in chronic HSJ patients. Magnetic resonance (MR) T1-weighted imaging, diffusion-weighted imaging, and MRS were performed in 41 chronic HSJ patients with suspected PSE and in 21 age-matched controls. The T1 signal intensity index (T1SI) and apparent diffusion coefficient (ADC) value were obtained in the Globus pallidus. Liver function was also investigated via serum ammonia and liver function tests. Higher T1SI and ADC values, increased lactate and glutamine levels, and decreased myo-inositol were found in the bilateral Globus pallidus in chronic HSJ patients with PSE. No significantly abnormal serum ammonia or liver function tests were observed in chronic HSJ patients with PSE. On the basis of these findings, we propose a diagnostic procedure for PSE in chronic HSJ patients. This study reveals that MRS can be useful for diagnosing PSE in chronic HSJ patients.
Highlights
Portal-systemic shunting is formed subsequent to portal hypertension, which is a common occurrence in patients with liver cirrhosis and can lead to neuropsychiatric abnormalities [1, 2]
The results demonstrate that magnetic resonance spectroscopy (MRS) would be useful for the diagnosis of Portal-systemic encephalopathy (PSE) in chronic hepatic schistosomiasis japonicum (HSJ) patients
This study was approved by the Institutional Review Board of Jinshan Hospital, and written informed consent was obtained in all cases prior to magnetic resonance imaging (MRI) and laboratory tests
Summary
Portal-systemic shunting is formed subsequent to portal hypertension, which is a common occurrence in patients with liver cirrhosis and can lead to neuropsychiatric abnormalities [1, 2]. Portal-systemic encephalopathy (PSE) is classified as type B hepatic encephalopathy, which is an important complication of chronic liver cirrhosis and/or portal-systemic shunting [2, 3]. Portal-systemic shunting is the main cause of PSE in hepatic schistosomiasis japonicum (HSJ) patients [4]. These patients were infected with Schistosoma japonicum many years previously, resulting in hepatopathy of varying severity at that time. The active HSJ was completely cured, one of the sequelae, i.e., portal-systemic shunting persisted. These allegedly cured chronic HSJ patients lack biochemical evidence of intrinsic liver disease [5]; they do not receive suitable clinical management. Chronic HSJ patients with covert PSE are usually clinically undetectable [1, 6]
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