Structural and functional abnormalities of vision-related brain regions in cirrhotic patients: a MRI study

Mingquan Wang,Xiaoxiao Wang,Yanpeng Liu,Bensheng Qiu,Yongqiang Yu,Yanming Wang,Benedictor Alexander Nguchu,Huijuan Wang,Jin Cui,Yawen Zhou,Yuying Zhu

doi:10.1007/s00234-019-02199-9

Abstract

PurposePrevious studies have focused on global cerebral alterations observed in cirrhosis. However, little was known about the specific abnormalities of vision-related brain regions in cirrhotic patients. In this study, we sought to explore neurological alterations of vision-related regions by measuring brain resting-state network connectivity, based on the structural investigation in cirrhotic patients without clinical sign of hepatic encephalopathy (HE).MethodsStructural and functional magnetic resonance image (MRI) data were collected from 20 hepatitis B virus (HBV)-related cirrhotic patients without clinical sign of HE and from 20 healthy controls (HC). Voxel-based morphometric (VBM) analysis and brain functional network analysis were performed to detect abnormalities in cerebral structure and function.ResultsCirrhotic patients showed regions with the most significant gray matter reduction primarily in vision-related brain regions, including the bilateral lingual gyri, left putamen, right fusiform gyrus, and right calcarine gyrus, and other significant gray matter reductions were distributed in bilateral hippocampus. Based on structural investigation focused on vision-related regions, brain functional network analysis revealed decreased functional connectivity between brain functional networks within vision-related regions (primary visual network (PVN), higher visual network (HVN), visuospatial network (VSN)) in the patient group compared with HC group.ConclusionThese results indicate that structural and functional impairment were evident in the vision-related brain regions in cirrhotic patients without clinical sign of hepatic encephalopathy. The physiopathology and clinical relevance of these changes could not be ascertained from the present study, which provided a basis for further evolution of the disease.

Highlights

Hepatitis B virus–related cirrhosis is a global public health problem characterized with high infection, morbidity, and mortality rates [1]
Voxel-based morphometric (VBM) analysis, based on the threshold-free cluster enhancement (TFCE) methods with family-wise error (FWE) correction, showed the specific pattern of gray matter deficits that we have identified in cirrhotic patients (Fig. 1)
Gray matter volume decreased in patient group was detected in the following areas: right lingual gyrus, right fusiform, and right calcarine gyrus compared with healthy controls (HC) group

Summary

Introduction

Hepatitis B virus–related cirrhosis is a global public health problem characterized with high infection, morbidity, and mortality rates [1]. In some case reports regards cirrhosis, the vision-related regions were shown to be affected, which lead to transient losses of the vision [5,6,7,8]. Zafiris et al have reported that cirrhotic patients without clinically overt hepatic encephalopathy (HE) showed impaired performance in vision capacity tasks with reference to the extrastriate visual cortex [9]. Cirrhotic studies based on MRI, a noninvasive imaging technique, have repeatedly reported the neuroimaging changes within different vision-related regions. MRI studies showed that cirrhotic patients exhibited a significant reduction in gray matter regions, in putamen, fusiform gyrus, and occipital regions [10,11,12]. A neuroimaging study has reported the occipital-parietal cortical edema by MRI and focal occipital status epilepticus by electroencephalogram (EEG) in the HBV-related hepatic disease [8].

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