亚临床肝性脑病患者脑MRI与1H MRS研究

目的利用MRI及^1H-MRS研究有与没有亚临床肝性脑病的肝硬化患者基底节区信号变化与代谢改变。方法27例肝硬化患者进行MRI与基底节区MRS扫描,其中男22例,女5例,年龄29-62岁,平均43岁,其中14例肝硬化患者有亚临床肝性脑病（经数字连接试验及符号数字试验测试）。18例年龄匹配的健康志愿者作对比,其中男13例,女5例,年龄24-51岁,平均38岁。结果有与没有亚临床肝性脑病的肝硬化患者结果及正常对照组间的NAA/Cr无显著性差异（P〉0.05）。没有亚临床肝性脑病的肝硬化患者及正常对照组间苍白球的高信号强度值、mI/Cr与Cho/Cr无显著性差异（P〉0.05）。有与没有亚临床肝性脑病的肝硬化患者间苍白球的高信号强度值、mI/Cr与Cho/Cr有显著性差异（P〈0.001）。结论肝硬化患者的亚临床肝性脑病与苍白球的高信号、基底节区mI/Cr、Cho/Cr有明显相关性。基底节区MRI与1H-MRS对判断是否有亚临床肝性脑病有重要的临床意义。

MRI and 1H-MRS study in patients with subclinical hepatic encephalopathy

Objective To study the signal changes and metabolic alterations in the basal ganglia (BG) by using MRI and proton magnetic resonance spectroscopy (¹H-MRS) in patients with subclinical hepatic encephalopathy (SHE). Methods MRI and ¹H-MRS in the basal ganglia in 27 patients (22 males, 5 females, the age ranged from 29 to 62 years, mean age 43 years) with definite liver cirrhosis were studied. Fourteen patients were classified as having SHE evaluated by number connection test (NCT)and symbol digit test (SDT). Eighteen age-matched healthy volunteers (13 males, 5 females, the age ranged from 24 to 51 years, mean age 38 years) underwent MRI and ¹H-MRS for comparison. Results NAA/Cr levels showed no statistical difference among patients with and without SHE and the control group (P>0.05). Values of signal hyperintensities in globus pallidus and ratios of mI/Cr and Cho/Cr showed no differences between the control group and the patients without SHE (P>0.05), whereas they were significantly different in patients without and with SHE (P<0.001). Conclusion Signal hyperintensities in globus pallidus and the mI/Cr and Cho/Cr ratios measured in the BG of patients correlated significantly with the SHE. MRI and ¹H-MRS in BG play significant roles in the determination of SHE.