Georgia Zeng1, Ross Penninkilampi1, Joga Chaganti1, Sara Montagnese1, Bruce J Brew1, Mark Danta2. 1. From the Faculty of Medicine (G.Z., B.B., M.D.), St Vincent's Clinical School, UNSW; Departments of Gastroenterology (G.Z., M.D.), Medical Imaging (J.C.), and Neurology and Immunology (B.B.), St Vincent's Hospital; Faculty of Medicine (R.P.), South Western Sydney Clinical School, UNSW, Sydney, Australia; and Department of Medicine (S.M.), University of Padua, Italy. 2. From the Faculty of Medicine (G.Z., B.B., M.D.), St Vincent's Clinical School, UNSW; Departments of Gastroenterology (G.Z., M.D.), Medical Imaging (J.C.), and Neurology and Immunology (B.B.), St Vincent's Hospital; Faculty of Medicine (R.P.), South Western Sydney Clinical School, UNSW, Sydney, Australia; and Department of Medicine (S.M.), University of Padua, Italy. m.danta@unsw.edu.au.
Abstract
OBJECTIVE: Various imaging modalities have been used to explore pathogenic mechanisms and stratify the severity of hepatic encephalopathy (HE). The hypothesis of this meta-analysis was that there is a progressive identifiable derangement of imaging measures using magnetic resonance spectroscopy (MRS) related to the severity of the HE. METHODS: Studies with more than 10 cases and HE diagnosis were identified from the electronic databases PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Literatura Latino Americana em Ciências da Saúde (LILACS), and Cochrane Central Register of Controlled Trials (CENTRAL) through July 25, 2018. Participants were stratified into healthy controls and patients with non-HE (NHE) (cirrhosis without HE), minimal HE (MHE), and overt HE (OHE). Analyses were organized by metabolite studied and brain region examined. Statistical meta-analysis was performed using the metafor package in R (v3.4.1). Pooled standardized mean differences between patient groups were calculated using a random effects model. RESULTS: We identified 31 studies (1,481 patients) that included data for cirrhosis-related HE. We found the parietal region to be the most reliable in differentiating between patients with and without MHE, with standard mean differences of +0.82 (95% confidence interval [CI] +0.49 to +1.15, p < 0.0001, I 2 = 37.45%) for glutamine/glutamate, -0.36 (95% CI -0.61 to -0.10, p = 0.007, I 2 = 20.00%) for choline, and-0.77 (95% CI -1.19 to -0.34, p = 0.0004, I 2 = 67.48%) for myo-inositol. We also found that glutamine/glutamate was the metabolite that reliably correlated with HE grade in all brain regions. CONCLUSIONS: The meta-analysis reveals that MRS changes in glutamine/glutamate, choline, and myo-inositol, particularly in the parietal lobe, correlate with the severity of HE. MRS may be of value in the assessment of HE.
OBJECTIVE: Various imaging modalities have been used to explore pathogenic mechanisms and stratify the severity of hepatic encephalopathy (HE). The hypothesis of this meta-analysis was that there is a progressive identifiable derangement of imaging measures using magnetic resonance spectroscopy (MRS) related to the severity of the HE. METHODS: Studies with more than 10 cases and HE diagnosis were identified from the electronic databases PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Literatura Latino Americana em Ciências da Saúde (LILACS), and Cochrane Central Register of Controlled Trials (CENTRAL) through July 25, 2018. Participants were stratified into healthy controls and patients with non-HE (NHE) (cirrhosis without HE), minimal HE (MHE), and overt HE (OHE). Analyses were organized by metabolite studied and brain region examined. Statistical meta-analysis was performed using the metafor package in R (v3.4.1). Pooled standardized mean differences between patient groups were calculated using a random effects model. RESULTS: We identified 31 studies (1,481 patients) that included data for cirrhosis-related HE. We found the parietal region to be the most reliable in differentiating between patients with and without MHE, with standard mean differences of +0.82 (95% confidence interval [CI] +0.49 to +1.15, p < 0.0001, I 2 = 37.45%) for glutamine/glutamate, -0.36 (95% CI -0.61 to -0.10, p = 0.007, I 2 = 20.00%) for choline, and-0.77 (95% CI -1.19 to -0.34, p = 0.0004, I 2 = 67.48%) for myo-inositol. We also found that glutamine/glutamate was the metabolite that reliably correlated with HE grade in all brain regions. CONCLUSIONS: The meta-analysis reveals that MRS changes in glutamine/glutamate, choline, and myo-inositol, particularly in the parietal lobe, correlate with the severity of HE. MRS may be of value in the assessment of HE.
Authors: Roosmarijn E Vandenbroucke; Christophe Van Steenkiste; Wouter Claeys; Lien Van Hoecke; Anja Geerts; Hans Van Vlierberghe; Sander Lefere; Griet Van Imschoot; Elien Van Wonterghem; Bart Ghesquière Journal: Sci Rep Date: 2022-10-20 Impact factor: 4.996