Severity-specific alterations in CBF, OEF and CMRO2 in cirrhotic patients with hepatic encephalopathy

Gang Zheng, Hanzhang Lu, Wenkui Yu, Song Luo, Ya Liu, Wei Liu, Hui Liu, Long Wu, Lijuan Zheng, Xiang Kong, Long Jiang Zhang, Guang Ming Lu

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objectives: To assess how the severity of hepatic encephalopathy (HE) affects perfusion and metabolic changes in cirrhotic patients and the association between severity and liver disease and anemia. Methods: The study groups comprised 31 healthy subjects and 33 cirrhotic patients who underwent MR examinations, and blood and neuropsychological tests. Of the cirrhotic patients, 14 were unaffected, and 11 had covert HE (CHE) and 8 overt HE (OHE). Global cerebral blood flow (CBF), oxygen extraction fraction (OEF), and metabolic rate of oxygen (CMRO2) were noninvasively measured by phase-contrast and T2-relaxation-under-spin-tagging MRI. Correlations were performed between MR measurements, hematocrits, ammonia levels, Child-Pugh scores and neuropsychological test scores. Results: Compared with the values in healthy subjects, CBF was higher in unaffected patients, the same in CHE patients and lower in OHE patients, OEF was higher in all patients, and CMRO2 was the same in unaffected and CHE patients and lower in OHE patients. Hematocrit was negatively correlated with CBF and OEF, but not with CMRO2. Ammonia level was negatively correlated with CBF and CMRO2, and Child-Pugh score was negatively correlated with CMRO2. Conclusions: The severity-associated alterations in cirrhotic patients indicate that homeostasis of oxygen delivery and oxidative metabolism in HE is regulated by multiple mechanisms. These physiological alterations appeared to be associated with the degree of anemia, ammonia level, and liver function. Key Points: • CBF, OEF and CMRO2 did not change monotonically with HE progression. • Anemia possibly contributed to CBF and OEF changes in cirrhotic patients. • Liver dysfunction mainly contributed to changes in CMRO2 in cirrhotic patients.

Original languageEnglish (US)
Pages (from-to)1-11
Number of pages11
JournalEuropean Radiology
DOIs
StateAccepted/In press - May 18 2017

Fingerprint

Cerebrovascular Circulation
Hepatic Encephalopathy
Oxygen
Ammonia
Anemia
Neuropsychological Tests
Hematocrit
Liver Diseases
Healthy Volunteers
Hematologic Tests

Keywords

  • Cerebral blood flow
  • Cerebral metabolic rate of oxygen
  • Cirrhosis
  • Hepatic encephalopathy
  • Oxygen extraction fraction

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Severity-specific alterations in CBF, OEF and CMRO2 in cirrhotic patients with hepatic encephalopathy. / Zheng, Gang; Lu, Hanzhang; Yu, Wenkui; Luo, Song; Liu, Ya; Liu, Wei; Liu, Hui; Wu, Long; Zheng, Lijuan; Kong, Xiang; Zhang, Long Jiang; Lu, Guang Ming.

In: European Radiology, 18.05.2017, p. 1-11.

Research output: Contribution to journalArticle

Zheng, G, Lu, H, Yu, W, Luo, S, Liu, Y, Liu, W, Liu, H, Wu, L, Zheng, L, Kong, X, Zhang, LJ & Lu, GM 2017, 'Severity-specific alterations in CBF, OEF and CMRO2 in cirrhotic patients with hepatic encephalopathy', European Radiology, pp. 1-11. https://doi.org/10.1007/s00330-017-4809-9
Zheng, Gang ; Lu, Hanzhang ; Yu, Wenkui ; Luo, Song ; Liu, Ya ; Liu, Wei ; Liu, Hui ; Wu, Long ; Zheng, Lijuan ; Kong, Xiang ; Zhang, Long Jiang ; Lu, Guang Ming. / Severity-specific alterations in CBF, OEF and CMRO2 in cirrhotic patients with hepatic encephalopathy. In: European Radiology. 2017 ; pp. 1-11.
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abstract = "Objectives: To assess how the severity of hepatic encephalopathy (HE) affects perfusion and metabolic changes in cirrhotic patients and the association between severity and liver disease and anemia. Methods: The study groups comprised 31 healthy subjects and 33 cirrhotic patients who underwent MR examinations, and blood and neuropsychological tests. Of the cirrhotic patients, 14 were unaffected, and 11 had covert HE (CHE) and 8 overt HE (OHE). Global cerebral blood flow (CBF), oxygen extraction fraction (OEF), and metabolic rate of oxygen (CMRO2) were noninvasively measured by phase-contrast and T2-relaxation-under-spin-tagging MRI. Correlations were performed between MR measurements, hematocrits, ammonia levels, Child-Pugh scores and neuropsychological test scores. Results: Compared with the values in healthy subjects, CBF was higher in unaffected patients, the same in CHE patients and lower in OHE patients, OEF was higher in all patients, and CMRO2 was the same in unaffected and CHE patients and lower in OHE patients. Hematocrit was negatively correlated with CBF and OEF, but not with CMRO2. Ammonia level was negatively correlated with CBF and CMRO2, and Child-Pugh score was negatively correlated with CMRO2. Conclusions: The severity-associated alterations in cirrhotic patients indicate that homeostasis of oxygen delivery and oxidative metabolism in HE is regulated by multiple mechanisms. These physiological alterations appeared to be associated with the degree of anemia, ammonia level, and liver function. Key Points: • CBF, OEF and CMRO2 did not change monotonically with HE progression. • Anemia possibly contributed to CBF and OEF changes in cirrhotic patients. • Liver dysfunction mainly contributed to changes in CMRO2 in cirrhotic patients.",
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T1 - Severity-specific alterations in CBF, OEF and CMRO2 in cirrhotic patients with hepatic encephalopathy

AU - Zheng, Gang

AU - Lu, Hanzhang

AU - Yu, Wenkui

AU - Luo, Song

AU - Liu, Ya

AU - Liu, Wei

AU - Liu, Hui

AU - Wu, Long

AU - Zheng, Lijuan

AU - Kong, Xiang

AU - Zhang, Long Jiang

AU - Lu, Guang Ming

PY - 2017/5/18

Y1 - 2017/5/18

N2 - Objectives: To assess how the severity of hepatic encephalopathy (HE) affects perfusion and metabolic changes in cirrhotic patients and the association between severity and liver disease and anemia. Methods: The study groups comprised 31 healthy subjects and 33 cirrhotic patients who underwent MR examinations, and blood and neuropsychological tests. Of the cirrhotic patients, 14 were unaffected, and 11 had covert HE (CHE) and 8 overt HE (OHE). Global cerebral blood flow (CBF), oxygen extraction fraction (OEF), and metabolic rate of oxygen (CMRO2) were noninvasively measured by phase-contrast and T2-relaxation-under-spin-tagging MRI. Correlations were performed between MR measurements, hematocrits, ammonia levels, Child-Pugh scores and neuropsychological test scores. Results: Compared with the values in healthy subjects, CBF was higher in unaffected patients, the same in CHE patients and lower in OHE patients, OEF was higher in all patients, and CMRO2 was the same in unaffected and CHE patients and lower in OHE patients. Hematocrit was negatively correlated with CBF and OEF, but not with CMRO2. Ammonia level was negatively correlated with CBF and CMRO2, and Child-Pugh score was negatively correlated with CMRO2. Conclusions: The severity-associated alterations in cirrhotic patients indicate that homeostasis of oxygen delivery and oxidative metabolism in HE is regulated by multiple mechanisms. These physiological alterations appeared to be associated with the degree of anemia, ammonia level, and liver function. Key Points: • CBF, OEF and CMRO2 did not change monotonically with HE progression. • Anemia possibly contributed to CBF and OEF changes in cirrhotic patients. • Liver dysfunction mainly contributed to changes in CMRO2 in cirrhotic patients.

AB - Objectives: To assess how the severity of hepatic encephalopathy (HE) affects perfusion and metabolic changes in cirrhotic patients and the association between severity and liver disease and anemia. Methods: The study groups comprised 31 healthy subjects and 33 cirrhotic patients who underwent MR examinations, and blood and neuropsychological tests. Of the cirrhotic patients, 14 were unaffected, and 11 had covert HE (CHE) and 8 overt HE (OHE). Global cerebral blood flow (CBF), oxygen extraction fraction (OEF), and metabolic rate of oxygen (CMRO2) were noninvasively measured by phase-contrast and T2-relaxation-under-spin-tagging MRI. Correlations were performed between MR measurements, hematocrits, ammonia levels, Child-Pugh scores and neuropsychological test scores. Results: Compared with the values in healthy subjects, CBF was higher in unaffected patients, the same in CHE patients and lower in OHE patients, OEF was higher in all patients, and CMRO2 was the same in unaffected and CHE patients and lower in OHE patients. Hematocrit was negatively correlated with CBF and OEF, but not with CMRO2. Ammonia level was negatively correlated with CBF and CMRO2, and Child-Pugh score was negatively correlated with CMRO2. Conclusions: The severity-associated alterations in cirrhotic patients indicate that homeostasis of oxygen delivery and oxidative metabolism in HE is regulated by multiple mechanisms. These physiological alterations appeared to be associated with the degree of anemia, ammonia level, and liver function. Key Points: • CBF, OEF and CMRO2 did not change monotonically with HE progression. • Anemia possibly contributed to CBF and OEF changes in cirrhotic patients. • Liver dysfunction mainly contributed to changes in CMRO2 in cirrhotic patients.

KW - Cerebral blood flow

KW - Cerebral metabolic rate of oxygen

KW - Cirrhosis

KW - Hepatic encephalopathy

KW - Oxygen extraction fraction

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