Combined diffusion tensor imaging and magnetic resonance spectroscopy to predict neurological outcome before transjugular intrahepatic portosystemic shunt

Marika Rudler, Nicolas Weiss, Vincent Perlbarg, Maxime Mallet, Simona Tripon, Romain Valabregue, Małgorzata Marjańska, Philippe Cluzel, Damien Galanaud, Dominique Thabut

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Background: Hepatic encephalopathy (HE) may occur after transjugular intrahepatic portosystemic shunt (TIPSS) placement. Multimodal magnetic resonance imaging (MRI), combining anatomical sequences, diffusion tensor imaging (DTI) and 1H magnetic resonance spectroscopy, is modified in cirrhotic patients. Aims: To describe multimodal MRI images before TIPSS, to assess if TIPSS induces changes in multimodal MRI, and to find predictors of HE after TIPSS in patients with cirrhosis. Methods: Consecutive cirrhotic patients with an indication for TIPSS were prospectively screened. Diagnosis of minimal HE was performed using psychometric HE test score. Multimodal MRI was performed before and 3 months after TIPSS placement. Results: Twenty-five consecutive patients were analysed (median age = 59, male gender 76%, median Child-Pugh score = 8 [5-8], MELD score = 12 [9-17], indication for TIPSS placement: ascites/secondary prophylaxis of variceal bleeding/other 20/3/2), no HE/minimal HE/overt HE: 21/4/0. 8/25 patients developed HE after TIPSS. Before TIPSS placement, metabolite concentrations were different in patients with or without minimal HE (lower myo-inositol, mI, higher glutamate/glutamine), but there were no differences in DTI data. TIPSS placement induced changes in metabolite concentrations even in asymptomatic patients, but not in DTI metrics. Baseline fractional anisotropy was significantly lower in patients who developed HE after TIPSS in five regions of interest. Conclusions: TIPSS placement induced significant changes in cerebral metabolites, even in asymptomatic patients. Patients who developed HE after TIPSS displayed lower fractional anisotropy before TIPSS. Brain MRI with DTI acquisition may help selecting patients at risk of HE.

Original languageEnglish (US)
Pages (from-to)863-874
Number of pages12
JournalAlimentary Pharmacology and Therapeutics
Issue number8
StatePublished - Oct 2018

Bibliographical note

Funding Information:
This study was supported by the programme FARE (Fonds d'Aide ? la Recherche et ? l'Evaluation en h?pato-gastroent?rologie) and le club francophone pour l??tude de l'hypertension portale. Declaration of personal and funding interests: None.

Publisher Copyright:
© 2018 John Wiley & Sons Ltd

Copyright 2018 Elsevier B.V., All rights reserved.

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