Abstract

BACKGROUND AND AIMS: We applied advanced magnetic resonance imaging and Voxed based Morphometry analysis to assess brain tissue density to 48 patients with cirrhosis without overt hepatic encephalopathy (17 Child A, 13 Child B, and 18 Child C) and 51 healthy subjects matched for age and sex. Seventeen patients had history of overt hepatic encephalopathy, 8 of them had minimal hepatic encephalopathy al inclusion, 10 other patients had minimal hepatic encephalopathy at inclusion but without history of previous overt hepatic encephalopathy. Finally, 21 patients had none of these features.

RESULTS: Patients with cirrhosis presented decreased brain density in many areas of the grey and white matter. The extension and size of the affected areas were greater in patients with alcoholic cirrhosis than in those with post-hepatitic cirrhosis and correlated directly with the degree of liver failure and cerebral dysfunction (as estimated by neuropsychological tests and the antecedent of overt hepatic encephalopathy). Twelve additional patients with cirrhosis submitted to liver transplantation were explored after a median time of 11 months (7-50 months) after liver transplant. At the time of liver transplantation 3 patients belonged to the class A of the Child Pugh classification, 5 to class B and 4 to class C. Compared to healthy subjects, liver transplant patients showed areas of reduced brain density in both grey and white matter.

CONCLUSIONS: These results indicate that loss of brain tissue density is common in cirrhosis, progresses during the course of the disease, is greater in patients with history of hepatic encephalopathy and persist after liver transplantation. The significance, physiopathology and clinical relevance of this abnormality cannot be ascertained from the current study.