Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Pattern Clustering of Symmetric Regional Cerebral Edema on Brain MRI in Patients with Hepatic Encephalopathy

간성뇌증 환자의 뇌 자기공명영상에서 대칭적인 지역 뇌부종 양상의 군집화

  • Chun Geun Lim (Department of Radiology, Kyungpook National University Hospital) ;
  • Hui Joong Lee (Department of Radiology, Kyungpook National University Hospital)
  • 임춘근 (경북대학교병원 영상의학과) ;
  • 이희중 (경북대학교병원 영상의학과)
  • Received : 2023.01.29
  • Accepted : 2023.06.11
  • Published : 2024.03.01
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose Metabolic abnormalities in hepatic encephalopathy (HE) cause brain edema or demyelinating disease, resulting in symmetric regional cerebral edema (SRCE) on MRI. This study aimed to investigate the usefulness of the clustering analysis of SRCE in predicting the development of brain failure. Materials and Methods MR findings and clinical data of 98 consecutive patients with HE were retrospectively analyzed. The correlation between the 12 regions of SRCE was calculated using the phi (φ) coefficient, and the pattern was classified using hierarchical clustering using the φ2 distance measure and Ward's method. The classified patterns of SRCE were correlated with clinical parameters such as the model for end-stage liver disease (MELD) score and HE grade. Results Significant associations were found between 22 pairs of regions of interest, including the red nucleus and corpus callosum (φ = 0.81, p < 0.001), crus cerebri and red nucleus (φ = 0.72, p < 0.001), and red nucleus and dentate nucleus (φ = 0.66, p < 0.001). After hierarchical clustering, 24 cases were classified into Group I, 35 into Group II, and 39 into Group III. Group III had a higher MELD score (p = 0.04) and HE grade (p = 0.002) than Group I. Conclusion Our study demonstrates that the SRCE patterns can be useful in predicting hepatic preservation and the occurrence of cerebral failure in HE.

목적 간성뇌증(hepatic encephalopathy; 이하 HE)의 대사이상은 뇌부종 또는 탈수초성 질환을 일으켜 자기공명영상에서 대칭적인 지역 뇌부종을 유발한다. 본 연구에서 HE 환자의 뇌 자기공명영상에서 대칭적인 지역 뇌부종 패턴의 군집화 분석을 통해 뇌부전 발생 예측의 유용성을 조사하는 것을 목적으로 한다. 대상과 방법 연속적인 HE 환자 98명을 대상으로 MR 소견과 임상자료를 후향적으로 분석하였다. Symmetric regional cerebral edema (이하 SRCE)의 12개 영역 간의 상관관계는 파이(φ) 계수를 사용하여 계산하였고, φ2 거리 측정과 Ward의 방법을 사용하여 계층적 군집화를 사용하여 패턴을 분류하였다. SRCE의 분류된 패턴은 말기 간 질환 모델(model for endstage liver disease; 이하 MELD) 점수 및 HE 등급과 같은 임상과 상관관계를 조사하였다. 결과 적색 핵과 뇌량(φ = 0.81, p < 0.001), 대뇌 십자 및 적색 핵(φ = 0.72, p < 0.001), 적색핵과 치상핵(φ = 0.66, p < 0.001)을 포함한 22쌍의 관심영역 사이에 유의한 연관성이 발견되었다. 계층적 군집화 후 24건을 I군, 35건을 II군, 39건을 III군으로 분류하였다. 그룹 III은 그룹 I에 비해 MELD 점수(p = 0.04)와 HE 등급(p = 0.002)이 더 높았다. 결론 본 연구는 HE 환자에서 대칭적인 지역 뇌부종의 패턴은 간 보존 및 뇌부전 발생을 예측하는 데 유용할 수 있음을 보여주었다.

Keywords

References

  1. Hazell AS, Butterworth RF. Hepatic encephalopathy: an update of pathophysiologic mechanisms. Proc Soc Exp Biol Med 1999;222:99-112
  2. Sherlock S. Hepatic encephalopathy. Br J Hosp Med 1977;17:144-146, 151-154, 159
  3. Rovira A, Alonso J, Cordoba J. MR imaging findings in hepatic encephalopathy. AJNR Am J Neuroradiol 2008;29:1612-1621
  4. Kreis R, Farrow N, Ross BD. Localized 1H NMR spectroscopy in patients with chronic hepatic encephalopathy. Analysis of changes in cerebral glutamine, choline and inositols. NMR Biomed 1991;4:109-116
  5. Inoue E, Hori S, Narumi Y, Fujita M, Kuriyama K, Kadota T, et al. Portal-systemic encephalopathy: presence of basal ganglia lesions with high signal intensity on MR images. Radiology 1991;179:551-555
  6. Lee DH, Lee HJ, Hahm MH. The pallidal index in patients with acute-on-chronic liver disease: is it a predictor of severe hepatic encephalopathy? Investig Magn Reson Imaging 2017;21:125-130
  7. Krieger D, Krieger S, Jansen O, Gass P, Theilmann L, Lichtnecker H. Manganese and chronic hepatic encephalopathy. Lancet 1995;346:270-274
  8. Rovira A, Cordoba J, Sanpedro F, Grive E, Rovira-Gols A, Alonso J. Normalization of T2 signal abnormalities in hemispheric white matter with liver transplant. Neurology 2002;59:335-341
  9. Cordoba J, Raguer N, Flavia M, Vargas V, Jacas C, Alonso J, et al. T2 hyperintensity along the cortico-spinal tract in cirrhosis relates to functional abnormalities. Hepatology 2003;38:1026-1033
  10. Finlayson MH, Superville B. Distribution of cerebral lesions in acquired hepatocerebral degeneration. Brain 1981;104(Pt 1):79-95
  11. de Oliveira AM, Paulino MV, Vieira APF, McKinney AM, da Rocha AJ, Dos Santos GT, et al. Imaging patterns of toxic and metabolic brain disorders. Radiographics 2019;39:1672-1695
  12. Soffer D, Sherman Y, Tur-Kaspa R, Eid A. Acquired hepatocerebral degeneration in a liver transplant recipient. Acta Neuropathol 1995;90:107-111
  13. Matsusue E, Kinoshita T, Ohama E, Ogawa T. Cerebral cortical and white matter lesions in chronic hepatic encephalopathy: MR-pathologic correlations. AJNR Am J Neuroradiol 2005;26:347-351
  14. vom Dahl S, Kircheis G, Haussinger D. Hepatic encephalopathy as a complication of liver disease. World J Gastroenterol 2001;7:152-156
  15. Abou-Assi S, Vlahcevic ZR. Hepatic encephalopathy. Metabolic consequence of cirrhosis often is reversible. Postgrad Med 2001;109:52-70
  16. Kleinschmidt-DeMasters BK, Filley CM, Rojiani AM. Overlapping features of extrapontine myelinolysis and acquired chronic (non-Wilsonian) hepatocerebral degeneration. Acta Neuropathol 2006;112:605-616
  17. Lim CG, Hahm MH, Lee HJ. Hepatic encephalopathy on magnetic resonance imaging and its uncertain differential diagnoses: a narrative review. J Yeungnam Med Sci 2023;40:136-145
  18. Blei AT, Cordoba J; Practice Parameters Committee of the American College of Gastroenterology. Hepatic encephalopathy. Am J Gastroenterol 2001;96:1968-1976
  19. Delis SG, Bakoyiannis A, Biliatis I, Athanassiou K, Tassopoulos N, Dervenis C. Model for end-stage liver disease (MELD) score, as a prognostic factor for post-operative morbidity and mortality in cirrhotic patients, undergoing hepatectomy for hepatocellular carcinoma. HPB (Oxford) 2009;11:351-357
  20. Albrecht J, Dolinska M. Glutamine as a pathogenic factor in hepatic encephalopathy. J Neurosci Res 2001;65:1-5
  21. Desjardins P, Belanger M, Butterworth RF. Alterations in expression of genes coding for key astrocytic proteins in acute liver failure. J Neurosci Res 2001;66:967-971
  22. Wright G, Sharifi Y, Jover-Cobos M, Jalan R. The brain in acute on chronic liver failure. Metab Brain Dis 2014;29:965-973
  23. Kim HK, Lee HJ, Lee W, Kim YS, Jang HW, Byun KH. Pattern approach to MR imaging in patients with endstage hepatic failure: a proposal for a new disease entity "hepatic encephalopathy continuum." Neuroradiology 2008;50:683-691
  24. Praharaj DL, Anand AC. Clinical implications, evaluation, and management of hyponatremia in cirrhosis. J Clin Exp Hepatol 2022;12:575-594
  25. Schrier RW, Gurevich AK, Cadnapaphornchai MA. Pathogenesis and management of sodium and water retention in cardiac failure and cirrhosis. Semin Nephrol 2001;21:157-172
  26. Adams R, Victor M, Mancall E. Central pontine myelinolysis: a hitherto undescribed disease occurring in alcoholic and malnourished patients. AMA Arch Neurol Psychiatry 1959;81:154-172
  27. Victor M, Adams RD, Cole M. The acquired (non-Wilsonian) type of chronic hepatocerebral degeneration. Medicine (Baltimore) 1965;44:345-396
  28. Gabriel S, Grossmann A, Hoppner J, Benecke R, Rolfs A. [Marchiafava-Bignami syndrome. Extrapontine myelinolysis in chronic alcoholism]. Nervenarzt 1999;70:349-356. German
  29. Heinrich A, Runge U, Khaw AV. Clinicoradiologic subtypes of Marchiafava-Bignami disease. J Neurol 2004;251:1050-1059
  30. Menegon P, Sibon I, Pachai C, Orgogozo JM, Dousset V. Marchiafava-Bignami disease: diffusion-weighted MRI in corpus callosum and cortical lesions. Neurology 2005;65:475-477
  31. Hwang E, Chang SK, Lee SA, Choi JA. A case of metronidazole-induced encephalopathy: atypical involvement of the brain on MRI. Investig Magn Reson Imaging 2018;22:200-203
  32. Kim HJ, Sunwoo MK, Lee JH, Choi YS, Kim DY. Methanol-induced encephalopathy: a case report. Investig Magn Reson Imaging 2017;21:61-64
  33. Romero-Gomez M, Montagnese S, Jalan R. Hepatic encephalopathy in patients with acute decompensation of cirrhosis and acute-on-chronic liver failure. J Hepatol 2015;62:437-447
  34. Joshi D, O'Grady J, Patel A, Shawcross D, Connor S, Deasy N, et al. Cerebral oedema is rare in acute-onchronic liver failure patients presenting with high-grade hepatic encephalopathy. Liver Int 2014;34:362-366