肝性脑病磁共振成像研究进展-LS课件

1、Brain Magnetic Resonance in Hepatic Encephalopathy Luo SongOutlineConceptClassificationClinical FeaturesPathophysiology MR charactersConclusionsConceptHepatic encephalopathy is a term encompassing a wide spectrum of neuropsychiatric abnormalities related to liver dysfunction that can be partially or

2、 completely reversible after function normalizes肝性脑病是由各种严重肝脏疾病引起的以代谢紊乱为基础的中枢神经系统功能失调综合征。ClassificationMechanism causeType A, associated with acute liver failure (ALF)Type B, associated with portal-systemic bypass without intrinsic hepatocellular disease Type C, associated with cirrhosis and portal h

3、yper- tension or portal-systemic shunts the most common typeLength or characteristics Overt HE(OHE) Episodic Persistent Minimal HE(MHE,轻微肝性脑病)PathophysiologyAbnormal accumulation of certain substances in the blood: ammonia, manganeseNeurotransmission abnormalityInjury to the astrocytesMicroglia acti

4、vation(neuroinflammation) DiagnosisClinical feature Imaging CT MRI PET/SPECTCFF(Critical Flicker Frequency)EEGNeuropsychological testsT1-Weighted/VolumetricHyperintensity（高信号） basal ganglia: globus pallidus, substantia nigra reticulate, and striatum limbic system (hippocampus, temporal lobe, cingula

5、te gyrus, and fornix) white matterBrain atrophy（脑萎缩）TIPS(经颈静脉门体分流术)12Volumetric MRIZhang LJ, et al. PLoS One, 2012Caudate（尾状核）Thalamus （丘脑）Volumetric MRITao R, et al. EJR, 2013Thalamus volume increase(丘脑体积增加)DWI and DTIBrain edemaDTIDMNQi R, et al.PLoS One , 2012 fMRITBSS and VBMTBSSVBMammoniaQi R,

6、Zhang LJ*, et al. Eur Radiol, 2013FA(FA)平均扩散率(MD)MHEBrain atrophyBain edemaGray matter decreaseWhiter matter FA decrease and MD increase丘脑尾状核Magnetization Transfer Imaging MTR decreaseBasal gangliaPosterior white matterMiese FR, et al. WJR, 2009Amplitude of low frequency fluctuation analysis（ALFF）Qi

7、 R, et al. Radiology, 2012Qi R, Zhang LJ*, et al. PloS One, DAN(背侧注意网络)DMN (脑默认网络)VN (视觉网络)AN (听觉网络)SMN(感觉运动网络)SRN(自我参照网络)25Resting-State Networks(ICA)Perfusion Imaging PWI(DSC)ASLZheng G, et al. EJR,2012CBF diffusely increase Pre-TIPS Post-TIPSMRS (1H-MRS, 31P-MRS, 13C-MRS )1H-MRS31P-MRS13C-MRSGlx increasemIns decreasewhite matter SWI Susceptibility increase left frontal white matter bilateral caudate head right substantia nigraOtherOtherT2* MRIDecrease l