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Non invasive blood flow measurement in cerebellum detects minimal hepatic encephalopathy earlier than psychometric tests

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Non invasive blood flow measurement in cerebellum detects minimal hepatic encephalopathy earlier than psychometric tests

dc.contributor.author	Felipo Orts, Vicente	es_ES
dc.contributor.author	Urios, Amparo	es_ES
dc.contributor.author	Giménez Garzó, Carla	es_ES
dc.contributor.author	Cauli, Omar	es_ES
dc.contributor.author	Andrés-Costa, Maria-Jesús	es_ES
dc.contributor.author	González, Olga	es_ES
dc.contributor.author	Serra, Miguel A	es_ES
dc.contributor.author	Sánchez-González, Javier	es_ES
dc.contributor.author	Aliaga, Roberto	es_ES
dc.contributor.author	Giner-Durán, Remedios	es_ES
dc.contributor.author	Belloch, Vicente	es_ES
dc.contributor.author	Montoliu Félix, Carmina	es_ES
dc.date.accessioned	2015-06-18T07:03:56Z
dc.date.available	2015-06-18T07:03:56Z
dc.date.issued	2014	es_ES
dc.identifier.citation	World Journal of Gastroenterology : WJG Vol. 20 Issue 33: pp. 11815-11825	es_ES
dc.identifier.uri	http://hdl.handle.net/10550/44427
dc.description.abstract	AIM: To assess whether non invasive blood flow measurement by arterial spin labeling in several brain regions detects minimal hepatic encephalopathy.METHODS: Blood flow (BF) was analyzed by arterial spin labeling (ASL) in different brain areas of 14 controls, 24 cirrhotic patients without and 16 cirrhotic patients with minimal hepatic encephalopathy (MHE). Images were collected using a 3 Tesla MR scanner (Achieva 3T-TX, Philips, Netherlands). Pulsed ASL was performed. Patients showing MHE were detected using the battery Psychometric Hepatic Encephalopathy Score (PHES) consisting of five tests. Different cognitive and motor functions were also assessed: alterations in selective attention were evaluated using the Stroop test. Patients and controls also performed visuo-motor and bimanual coordination tests. Several biochemical parameters were measured: serum pro-inflammatory interleukins (IL-6 and IL-18), 3-nitrotyrosine, cGMP and nitrates+nitrites in plasma, and blood ammonia. Bivariate correlations were evaluated.RESULTS: In patients with MHE, BF was increased in cerebellar hemisphere (P = 0.03) and vermis (P = 0.012) and reduced in occipital lobe (P = 0.017). BF in cerebellar hemisphere was also increased in patients without MHE (P = 0.02). Bimanual coordination was impaired in patients without MHE (P = 0.05) and much more in patients with MHE (P < 0.0001). Visuo-motor coordination was impaired only in patients with MHE (P < 0.0001). Attention was slightly affected in patients without MHE and more strongly in patients with MHE (P < 0.0001). BF in cerebellar hemisphere and vermis correlated with performance in most tests of PHES [(number connection tests A (NCT-A), B (NCT-B)and line tracing test] and in the congruent task of Stroop test. BF in frontal lobe correlated with NCT-A. Performance in bimanual and visuomotor coordination tests correlated only with BF in cerebellar hemisphere. BF in occipital lobe correlates with performance in the PHES battery and with CFF. BF in cerebellar hemisphere correlates with plasma cGMP and nitric oxide (NO) metabolites. BF in vermis cerebellar also correlates with NO metabolites and with 3-nitrotyrosine. IL-18 in plasma correlates with BF in thalamus and occipital lobe.CONCLUSION: Non invasive BF determination in cerebellum using ASL may detect MHE earlier than the PHES. Altered NO-cGMP pathway seems to be associated to altered BF in cerebellum.	es_ES
dc.subject	Arterial spin labelling	es_ES
dc.subject	Neurological impairment	es_ES
dc.subject	Blood flow	es_ES
dc.subject	Cerebellum	es_ES
dc.subject	Minimal hepatic encephalopathy	es_ES
dc.title	Non invasive blood flow measurement in cerebellum detects minimal hepatic encephalopathy earlier than psychometric tests	es_ES
dc.type	journal article	es_ES
dc.identifier.doi	10.3748/wjg.v20.i33.11815	es_ES
dc.identifier.idgrec	102043	es_ES