肝性脑病磁共振成像研究进展课件

BrainMagneticResonanceinHepaticEncephalopathyLuoSongOutlineConceptClassificationClinicalFeaturesPathophysiologyMRcharactersConclusionsConceptHepaticencephalopathyisatermencompassingawidespectrumofneuropsychiatricabnormalitiesrelatedtoliverdysfunctionthatcanbepartiallyorcompletelyreversibleafterfunctionnormalizes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。ClassificationMechanismcauseTypeA,associatedwithacuteliverfailure(ALF)TypeB,associatedwithportal-systemicbypasswithoutintrinsichepatocellulardiseaseTypeC,associatedwithcirrhosisandportalhyper-tensionorportal-systemicshuntsthemostcommontypeLengthorcharacteristicsOvertHE(OHE)EpisodicPersistent

MinimalHE(MHE,轻微肝性脑病)ClinicalFeaturesOHEMotoralterationsrigidity,speechdisorders,tremor,hyperreflexia,hyporeflexia,babinskisignsMentalabnormalitiesrangefrommildchangestocomaMHE

impairedshort-andlong-termmemorydepressionandanxietyPathophysiologyAbnormalaccumulationofcertainsubstancesintheblood:ammonia,manganeseNeurotransmissionabnormalityInjurytotheastrocytesMicrogliaactivation(neuroinflammation)DiagnosisClinicalfeatureImagingCT

MRIPET/SPECTCFF(CriticalFlickerFrequency)EEGNeuropsychologicaltestsMRIinHET1-Weighted/VolumetricT2-Weighted/T2-FlairDWI/DTIMTIFMRIPerfusionMRS(1H-MRS,31P-MRS,13C-MRS)Other(SWI,T2*)T1-Weighted/VolumetricHyperintensity（高信号）basalganglia:globuspallidus,substantianigrareticulate,andstriatumlimbicsystem(hippocampus,temporallobe,cingulategyrus,andfornix)whitematterBrainatrophy（脑萎缩）TIPS(经颈静脉门体分流术)12BrainatrophyVolumetricMRIZhangLJ,etal.PLoSOne,2012Caudate（尾状核）

Thalamus（丘脑）VolumetricMRITaoR,etal.EJR,2013Thalamusvolumeincrease(丘脑体积增加)T2-Weighted/T2-FLAIRDiffusehighsignalintensitywhitematterlesionsinoraroundthecorticospinaltractDWIandDTIBrainedemaTHANKYOUSUCCESS2024/1/2419.DTIDMNQiR,etal.PLoSOne,2012fMRITBSSandVBMTBSSVBMammoniaQiR,ZhangLJ*,etal.EurRadiol,2013FA(FA)平均扩散率(MD)MHEBrainatrophyBainedemaGraymatterdecreaseWhitermatterFAdecreaseandMDincrease丘脑尾状核MagnetizationTransferImagingMTRdecreaseBasalgangliaPosteriorwhitematterMieseFR,etal.WJR,2009FunctionalMRI(fMRI)ZhangLJ,etal.HBM,2011Default-modenetwork(DMN)LPCC,precuneus,RAG,MFCleftparahippocampusHCHEAmplitudeoflowfrequencyfluctuationanalysis（ALFF）QiR,etal.Radiology,2012QiR,ZhangLJ*,etal.PloSOne,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)26Resting-StateNetworks(ICA)ZhangLJ*,etal.Radiology,2012basalganglia–thalamocorticalcircuitWidespreadcorticalandsubcorticalnetworkconnectivitychangesFunctionalnetwork27PerfusionImagingPWI(DSC)ASLZhengG,etal.EJR,2012CBFdiffuselyincreasePre-TIPSPost-TIPSMRS(1H-MRS,31P-MRS,13C-MRS)1H-MRS31P-MRS13C-MRSGlxincreasemInsdecreasewhitematter

SWISusceptibilityincreaseleftfrontalwhitematterbilateralcaudateheadrightsubstantianigraOtherOtherT2*MRIDecrease