Study Of Brain Changes In Chronic Hepatic Encephalopathy By Using MR Imaging

Hepatic encephalopathy reflects a spectrum of neuro-psychiatric abnormalities including personality change, intellectual impairment, involuntary movements and depressed level of consciousness. So used MRI to identify these lesions and help in diagnosis of hepatic encephalopathy.Objective: To evaluate MR imaging of the brain in different grades of chronic hepatic encephalopathy and its correlation with clinical neurological abnormality.Methods: from January 2009 to January 2012, in Tropical Medicine Department, Zagazig University Hospitals, 60 patients, 40 patient with chronic hepatic encephgalopathy which divided into two groups, group (I) chronic peristant hepatic encephalopathy which having positivity of psychometric test and having some neurological manifestation according to west haven criteria, these patients lie in grade I-II, 2nd group chronic relapsing hepatic encephalopathy, no neurological manifestation and patient appear alert and when doing psychometric test find negativity for this test. 20 patients early compensated cirrhosis as control group for all patient doing routine investigation, MR imaging on the brain and estimation ammonia and Mn level in the blood.Result: In our study child score was high among patient in GI (11.51.54) in comparison to other group with P<0.001 and in this study found significant increased signal intensity of T1 and T2 of MRI on the brain in GI compare to other groups with statistical significant increase of glutamine in GI (2.781.1) when compare to other groups with P<0.001 and found in these study high serum level of ammonia in GI (162.155.8) and high serum level of manganes in GI (3.350.34) when compare to other groups. We found relation between Mn level in blood of hepatic patients and T1 signal image of the brain which found significant increase in T1 signals with increase serum level of Mn (2.910.6) with P<0.001 and found significant increase in signal intensity in T2 in corresponding to elevation of level of ammonia in blood (116.949) with P<0.001.Conclusion: Liver damage severity is associated with accumulation of Mn in brain of patients. Changes in brain metabolites as detected by H-MRS may be sensitive markers for clinical monitoring of brain dysfunction and cognitive impairment in these patient. MRI and MRS give us early referral parameter for selection the priority patients for liver transplantation..