Early Primary Biliary Cholangitis is Characterised by Brain Abnormalities on Cerebral Magnetic Resonance Imaging

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Title: Early Primary Biliary Cholangitis is Characterised by Brain Abnormalities on Cerebral Magnetic Resonance Imaging
Authors: Grover, VP
Southern, L
Dyson, JK
Kim, JU
Crossey, MM
Wylezinska-Arridge, M
Patel, N
Fitzpatrick, JA
Bak-Bol, A
Waldman, AD
Alexander, GJ
Mells, GF
Chapman, RW
Jones, DE
Taylor-Robinson, SD
Item Type: Journal Article
Abstract: Background: Brain change can occur in primary biliary cholangitis (PBC), potentially as a result of cholestatic and/or inflammatory processes. This change is linked to systemic symptoms of fatigue and cognitive impairment. Aim: To identify whether brain change occurs early in PBC. If the change develops early and is progressive, it may explain the difficulty in treating these symptoms. Methods: Early disease brain change was explored in 13 patients with newly diagnosed biopsy-proven pre-cirrhotic PBC using magnetization transfer, diffusion-weighted imaging and 1H magnetic resonance spectroscopy. Results were compared to 17 healthy volunteers. Results: Cerebral magnetization transfer ratios were reduced in early PBC, compared to healthy volunteers, in the thalamus, putamen and head of caudate with no greater reduction in patients with greater symptom severity. Mean apparent diffusion coefficients were increased in the thalamus only. No 1H magnetic resonance spectroscopy abnormalities were seen. Serum manganese levels were elevated in all PBC patients, but no relationship was seen with imaging or symptom parameters. There were no correlations between neuroimaging data, laboratory data, symptom severity scores or age. Conclusions: This is the first study to be performed in this pre-cirrhotic patient population and we have highlighted that neuroimaging changes are present at a much earlier stage than previously demonstrated. The neuroimaging abnormalities suggest that the brain changes seen in PBC occur early in the pathological process, even before significant liver damage has occurred. If such changes are linked to symptom pathogenesis, this could have important implications for the timing of second-line-therapy use.
Issue Date: 8-Sep-2016
Date of Acceptance: 19-Aug-2016
ISSN: 1365-2036
Publisher: Wiley
Start Page: 936
End Page: 945
Journal / Book Title: Alimentary Pharmacology & Therapeutics
Volume: 44
Issue: 9
Copyright Statement: © 2016 The Authors. Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use,distribution and reproduction in any medium, provided the original work is properly cited.
Sponsor/Funder: Royal College of Physicians
University of London
Friends of Hammersmith Hospital
Imperial College Healthcare NHS Trust
Imperial College Healthcare NHS Trust- BRC Funding
Medical Research Council (MRC)
Funder's Grant Number: BUPA FELLOWSHIP 2004
RDA15 79560
Keywords: Gastroenterology & Hepatology
1103 Clinical Sciences
1115 Pharmacology And Pharmaceutical Sciences
Publication Status: Published
Appears in Collections:Division of Surgery
Department of Medicine
Faculty of Medicine

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