Magnetic Resonance T 2-Relaxometry and 2 D L-Correlated Spectroscopy in Patients with Minimal Hepatic Encephalopathy

Purpose—To evaluate T2-relaxation changes in patients with minimal hepatic encephalopathy (MHE) using T2-relaxometry and to correlate T2 values with brain metabolites evaluated using two-dimensional (2D) magnetic resonance spectroscopy (MRS). Materials and Methods—Eight MHE patients and 13 healthy subjects were evaluated using T2-relaxometry, and 8 patients and 9 healthy subjects underwent 2D MRS in right frontal and left occipital regions. Whole brain T2-relaxation maps were compared between MHE and control subjects using analysis-of-covariance, with age and gender included as covariates. T2 values derived from the right frontal and left occipital lobes were correlated with the metabolite ratios. Results—Multiple brain regions including anterior and mid cingulate cortices, right anterior and left posterior insular cortices, right prefrontal, medial frontal, and right superior temporal cortices showed significantly increased T2 values in MHE patients compared to control subjects. MRS showed significantly increased ratios of glutamine/glutamate (Glx) and decreased ratios of myoinositol, taurine, choline, and myo-inositol/choline (mICh) with respect to creatine (Cr_d) in patients compared to controls. Frontal Glx/Cr_d showed significantly positive correlation with T2 values. Conclusion—MHE patients showed significantly increased T2 values in multiple brain regions reflecting increased free water content and T2 values in frontal lobe correlated with the increased Glx/Cr_d ratio.

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