The correlation between the ReHo values and Glasgow Coma Scale in patients with overt hepatic encephalopathy.

<p>The Glasgow Coma Scale negatively correlated with ReHo values in the left cerebellar crus I.</p

Analysis of demographic variables and cognitive assessments between the healthy controls and patients with OHE.

<p>Means and standard deviations of raw scores for the healthy control group and the patients with OHE. For each variable, the p value indicates the significance level of the appropriate statistical test comparing the raw scores of the control group and the patients with OHE. Abbreviations: CSFV, cerebrospinal fluid volume; GMV, gray matter volume; TIV, total intracranial volume; WMV, white matter volume.</p><p>* P value < 0.05</p><p>Analysis of demographic variables and cognitive assessments between the healthy controls and patients with OHE.</p

Scattergram and box plot of ReHo among eight survivor and four non-survivor cirrhotic patients with overt hepatic encephalopathy (OHE).

<p>The mean ReHo values of the right superior temporal gyrus was lower in the non-survivors compared to the survivors (-0.48 vs. -0.16, <i>p</i> = 0.016). The mean ReHo values of the left cerebellar crus I was higher in the non-survivors than in the survivors (1.24 vs. 0.66, <i>p</i> = 0.015). Boxes represent the 25th and 75th percentiles, and the lines in the boxes indicate the medians. Upper and lower lines of whiskers represent minimum and maximum values. ReHo, regional homogeneity; AU, arbitrary unit; *<i>p</i><0.05</p

Brain regions with abnormal regional homogeneity in cirrhotic patients with overt hepatic encephalopathy.

<p>Results were according to the automated anatomical labeling software package and digital atlas of the human brain. Multiple comparisons were corrected using Monte Carlo simulations with a corrected threshold of <i>p</i><0.05. The threshold of the cluster size was 40 calculated by the following parameters: single voxel p = 0.01, 1,000 simulations, FWHW = 6 mm, cluster connection radius = 5 mm with grey matter mask.</p><p>Brain regions with abnormal regional homogeneity in cirrhotic patients with overt hepatic encephalopathy.</p

Mean ReHo maps of patients with overt hepatic encephalopathy (lower column) and healthy controls (upper column).

<p>The prefrontal cortex, lingual gyrus, middle temporal gyrus, bilateral precentral gyrus, paracentral lobule and precuneus exhibited significantly higher ReHo values than the global mean ReHo values of both groups (<i>p</i><0.01, false discovery rate corrected), but had different strengths between the two groups.</p

A random effect two sample t-statistical difference map between patients with overt hepatic encephalopathy (OHE) and healthy controls.

<p>The OHE patients showed significantly decreased ReHo in the (1) left middle cingulum, (2) left superior temporal gyrus, (3) right superior temporal gyrus, (4) left inferior orbito-frontal gyrus, (5) right calcarine, (6) triangular part of left inferior frontal gyrus, (7) left post-central gyrus, (8) left inferior temporal gyrus, and (9) left lingual, and increased ReHo in the (10) right superior frontal gyrus, (11) right inferior temporal gyrus, (12) right caudate, and (13) left crus II, (14) left crus I, and (15) right crus II of the cerebellum. T-score bars were shown on the right. Hot and cold colors indicated increased and decreased ReHo in OHE patients compared to controls, respectively. These criteria met a corrected threshold of <i>p</i><0.05.</p

Longitudinal Brain White Matter Alterations in Minimal Hepatic Encephalopathy before and after Liver Transplantation

<div><p>Cerebral edema is the common pathogenic mechanism for cognitive impairment in minimal hepatic encephalopathy. Whether complete reversibility of brain edema, cognitive deficits, and their associated imaging can be achieved after liver transplantation remains an open question. To characterize white matter integrity before and after liver transplantation in patients with minimal hepatic encephalopathy, multiple diffusivity indices acquired via diffusion tensor imaging was applied. Twenty-eight patients and thirty age- and sex-matched healthy volunteers were included. Multiple diffusivity indices were obtained from diffusion tensor images, including mean diffusivity, fractional anisotropy, axial diffusivity and radial diffusivity. The assessment was repeated 6–12 month after transplantation. Differences in white matter integrity between groups, as well as longitudinal changes, were evaluated using tract-based spatial statistical analysis. Correlation analyses were performed to identify first scan before transplantation and interval changes among the neuropsychiatric tests, clinical laboratory tests, and diffusion tensor imaging indices. After transplantation, decreased water diffusivity without fractional anisotropy change indicating reversible cerebral edema was found in the left anterior cingulate, claustrum, postcentral gyrus, and right corpus callosum. However, a progressive decrease in fractional anisotropy and an increase in radial diffusivity suggesting demyelination were noted in temporal lobe. Improved pre-transplantation albumin levels and interval changes were associated with better recoveries of diffusion tensor imaging indices. Improvements in interval diffusion tensor imaging indices in the right postcentral gyrus were correlated with visuospatial function score correction. In conclusion, longitudinal voxel-wise analysis of multiple diffusion tensor imaging indices demonstrated different white matter changes in minimal hepatic encephalopathy patients. Transplantation improved extracellular cerebral edema and the results of associated cognition tests. However, white matter demyelination may advance in temporal lobe.</p></div

Regions of longitudinal changes in white matter microstructure between baseline and follow-up scan in MHE patients.

<p>Mean FA values were directly obtained from clusters showing significant changes between baseline and follow-up scan. Z_max values represent TFCE FWE-corrected clusters (p<.05). Multiple brain atlases implemented in FSL were used to define anatomical regions of significant clusters after statistical comparisons. Diffusivity values corresponding to each cluster with significant longitudinal changes are represented as differences (baseline – follow up) in MD, D_ax and D_rad (mm²/s) multiplied by a factor of 10⁶. Boldfaced diffusivity values with “*” represent significant differences (<i>P</i><.05, Bonferroni-adjusted) between baseline and follow-up scans.</p><p>Abbreviations: FA, fractional anisotropy; MNI, Montreal Neurological Institute; SD, standard deviation; DTI, diffusion-tensor imaging; D_ax, axial diffusivity; MD, mean diffusivity; D_rad, radial diffusivity; BA, Brodmann area; TFCE, threshold-free cluster enhancement; FWE, family-wise error.</p><p>Regions of longitudinal changes in white matter microstructure between baseline and follow-up scan in MHE patients.</p

Demographics, clinical characteristics, and cognitive test results of minimal hepatic encephalopathy patients and healthy controls.

<p>Demographic data, including age and sex, were compared among the study groups using the two-sample Student’s <i>t</i> test, Pearson’s chi-squared test, and paired <i>t</i> test, where appropriate, and are reported as means ± standard deviation (SD).</p><p>Abbreviations: WASI, Wechsler Abbreviated Scale of Intelligence; CASI, Cognitive Ability Screening Instrument.</p><p>Statistical threshold was set at <i>p</i><0.05 (Boldface).</p><p>*Stand for the appropriate test passed the statistical criteria set at corrected P_{false-discovery-rate} <0.05.</p><p>Demographics, clinical characteristics, and cognitive test results of minimal hepatic encephalopathy patients and healthy controls.</p

Regions showing significant FA reduction in follow-up scan compared with baseline scan.

<p>Regions with decreased FA following LT (threshold-free cluster enhancement corrected for multiple comparisons at P_FWE <.05). Number 1, Right parahippocampal gyrus; blue scale color maps indicate the degree of corrected p-value. Anatomical changes are superimposed on the mean WM skeleton and on the T1 template located in MNI space in (A) sagittal and (B) axial views. The tbss_fill script was used to aid visualization. The numbers in the lower right corner of each image represent the MNI (A) x- and (B) z-coordinates respectively. Abbreviations: FWE, family-wise error; MNI, Montreal Neurological Institute.</p