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A longitudinal study of patients with cirrhosis treated with L-ornithine L-aspartate, examined with magnetization transfer, diffusion-weighted imaging and magnetic resonance spectroscopy

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Title: A longitudinal study of patients with cirrhosis treated with L-ornithine L-aspartate, examined with magnetization transfer, diffusion-weighted imaging and magnetic resonance spectroscopy
Authors: Grover, VP
McPhail, M
Wylezinska, M
Crossey, MM
Fitzpatrick, J
Southern, L
Saxby, B
Cook, NA
Cox, IJ
Waldman, A
Dhanjal, N
Bak-Bol, A
Williams, R
Morgan, MY
Taylor-Robinson, SD
Item Type: Journal Article
Abstract: The presence of overt hepatic encephalopathy (HE) is associated with structural, metabolic and functional changes in the brain discernible by use of a variety of magnetic resonance (MR) techniques. The changes in patients with minimal HE are less well documented. Twenty-two patients with well-compensated cirrhosis, seven of whom had minimal HE, were examined with cerebral 3 Tesla MR techniques, including T1- and T2-weighted, magnetization transfer and diffusion-weighted imaging and proton magnetic resonance spectroscopy sequences. Studies were repeated after a 4-week course of oral L-ornithine L-aspartate (LOLA). Results were compared with data obtained from 22 aged-matched healthy controls. There was no difference in mean total brain volume between patients and controls at baseline. Mean cerebral magnetization transfer ratios were significantly reduced in the globus pallidus and thalamus in the patients with cirrhosis irrespective of neuropsychiatric status; the mean ratio was significantly reduced in the frontal white matter in patients with minimal HE compared with healthy controls but not when compared with their unimpaired counterparts. There were no significant differences in either the median apparent diffusion coefficients or the mean fractional anisotropy, calculated from the diffusion-weighted imaging, or in the mean basal ganglia metabolite ratios between patients and controls. Psychometric performance improved in 50% of patients with minimal HE following LOLA, but no significant changes were observed in brain volumes, cerebral magnetization transfer ratios, the diffusion weighted imaging variables or the cerebral metabolite ratios. MR variables, as applied in this study, do not identify patients with minimal HE, nor do they reflect changes in psychometric performance following LOLA.
Issue Date: 3-Aug-2016
Date of Acceptance: 25-Jul-2016
URI: http://hdl.handle.net/10044/1/37475
DOI: https://dx.doi.org/10.1007/s11011-016-9881-3
ISSN: 1573-7365
Publisher: Springer Verlag
Start Page: 77
End Page: 86
Journal / Book Title: Metabolic Brain Disease
Volume: 32
Issue: 1
Copyright Statement: © The Author(s) 2016. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
Sponsor/Funder: Imperial College Trust
Friends of Hammersmith Hospital
Medical Research Council (MRC)
National Institutes of Health
Imperial College Healthcare NHS Trust- BRC Funding
Funder's Grant Number: PC2929 01/06/2002
None
G0700528
5R01AA020203-02
RDC04 79560
Keywords: Science & Technology
Life Sciences & Biomedicine
Endocrinology & Metabolism
Neurosciences
Neurosciences & Neurology
Cirrhosis
Hepatic encephalopathy
Magnetic resonance imaging
Spectroscopy
MINIMAL HEPATIC-ENCEPHALOPATHY
CHRONIC LIVER-DISEASE
GRADE CEREBRAL EDEMA
WHITE-MATTER
CONTRAST MEASUREMENTS
MR SPECTROSCOPY
BASAL GANGLIA
BRAIN
PROTON
COEFFICIENT
1103 Clinical Sciences
1109 Neurosciences
Neurology & Neurosurgery
Publication Status: Published
Appears in Collections:Division of Surgery
Department of Medicine
Faculty of Medicine



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