肝性脑病的影像学进展

Progress of medical imaging on hepatic encephalopathy

肝性脑病是严重肝病引起的神经系统代谢紊乱的综合征。亚临床性肝性脑病无明显的临床表现和生化异常,用精细的智力测验和(或)电生理检测可以发现异常。早期探测肝硬化患者神经精神障碍对于患者的预后及提高生活质量是很重要的。脑功能成像包括波谱检查和灌注成像可以发现患者脑内的改变,对于该病的诊断和进一步理解病生理机制是极其有帮助的。波谱检查发现脑内谷氨酰胺的增加和肌醇峰、胆碱峰的降低。灌注检查提示皮层弥漫性的灌注降低及基底节区代偿性的增加。

Hepatic encephalopathy (HE) is a neurometabolic disorder syndrome caused by severe hepatic disease. Subclinical hepatic encephalopathy (SHE) without obvious symptoms and abnormal lab examinations can be detected by sensitive intelligent or neuropsychological examinations. Early detection of neuropsychological dysfunction in cirrhotic patients without overt encephalopathy is essential to their prognosis and quality of life. Functional neuroimaging, including spectroscopy and perfusion imaging, is very helpful in diagnosing early HE and understanding the pathophysiological mechanisms. MR spectroscopy demonstrates increased cerebral glutamine and decreased myoinositol and choline metabolites. Perfusion imaging discloses diffuse cortical perfusion impairment and compensated increase in basal ganglion.