Delineation of microhemorrhage in acute hepatic encephalopathy using susceptibility-weighted imaging

John C. Benson, Seyedmehdi Payabvash, Gregory L. Thalken, Juli Alonso, Jeffrey Rykken, Frederick Ott, Alexander M. McKinney

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Introduction Microhemorrhages (MH's) in patients with acute hepatic encephalopathy (AHE) have scarcely been described. This study set out to assess if MH's occur in characteristic locations and frequency in patients with AHE superimposed on chronic liver failure, and to determine if such findings correlate with the clinical and MRI severity. Materials and methods Over a 4.5-year period, AHE patients with SWI MRI were included. The maximum plasma ammonia level (PAL), number and location of "frank" hemorrhages (>5 mm size) or MH's (<5 mm) on SWI, and severity of DWI and FLAIR were recorded. Susceptibility foci in the basal ganglia were disregarded, as those changes might represent common mineralization. The presence of MH's was correlated with the MRI and clinical severity. Results Punctate MH foci were found in 18/38 (47.4%) patients. The most common locations were periventricular white matter (6/38 patients, 15.8%) and cerebral cortex (5/38, 13.2%). Of 47 MH's, only a tiny minority (8.5%) occurred in regions of abnormality on FLAIR or DWI. Both the MRI severity on FLAIR (r = 0.420, p = 0.013) and DWI (r = 0.320, p = 0.045) mildly correlated with clinical outcome, but the correlation was not significant after Bonferroni correction. No significant correlation was found between the number of MH's and the clinical score, clinical outcome, FLAIR severity, or DWI severity (range r = -0.083-0.152, p = 0.363-0.618). The number of MH's was not significantly different among various vasculopathies. Foci on SWI improved in two patients following liver transplantation. Conclusion SWI-positive foci outside of the basal ganglia (presumed MH's) are present in nearly half of AHE patients, but do not portend outcome. Regions with the most observed MH's were the periventricular white matter, cortical gray matter, and subcortical white matter.

Original languageEnglish (US)
Pages (from-to)629-634
Number of pages6
JournalEuropean Journal of Radiology
Volume85
Issue number3
DOIs
StatePublished - Mar 1 2016

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Hepatic Encephalopathy
Basal Ganglia
End Stage Liver Disease
Ammonia
Cerebral Cortex
Liver Transplantation
Hemorrhage
White Matter

Keywords

  • Acute hepatic encephalopathy
  • Microhemorrhage
  • Susceptibility weighted imaging

Cite this

Delineation of microhemorrhage in acute hepatic encephalopathy using susceptibility-weighted imaging. / Benson, John C.; Payabvash, Seyedmehdi; Thalken, Gregory L.; Alonso, Juli; Rykken, Jeffrey; Ott, Frederick; McKinney, Alexander M.

In: European Journal of Radiology, Vol. 85, No. 3, 01.03.2016, p. 629-634.

Research output: Contribution to journalArticle

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title = "Delineation of microhemorrhage in acute hepatic encephalopathy using susceptibility-weighted imaging",
abstract = "Introduction Microhemorrhages (MH's) in patients with acute hepatic encephalopathy (AHE) have scarcely been described. This study set out to assess if MH's occur in characteristic locations and frequency in patients with AHE superimposed on chronic liver failure, and to determine if such findings correlate with the clinical and MRI severity. Materials and methods Over a 4.5-year period, AHE patients with SWI MRI were included. The maximum plasma ammonia level (PAL), number and location of {"}frank{"} hemorrhages (>5 mm size) or MH's (<5 mm) on SWI, and severity of DWI and FLAIR were recorded. Susceptibility foci in the basal ganglia were disregarded, as those changes might represent common mineralization. The presence of MH's was correlated with the MRI and clinical severity. Results Punctate MH foci were found in 18/38 (47.4{\%}) patients. The most common locations were periventricular white matter (6/38 patients, 15.8{\%}) and cerebral cortex (5/38, 13.2{\%}). Of 47 MH's, only a tiny minority (8.5{\%}) occurred in regions of abnormality on FLAIR or DWI. Both the MRI severity on FLAIR (r = 0.420, p = 0.013) and DWI (r = 0.320, p = 0.045) mildly correlated with clinical outcome, but the correlation was not significant after Bonferroni correction. No significant correlation was found between the number of MH's and the clinical score, clinical outcome, FLAIR severity, or DWI severity (range r = -0.083-0.152, p = 0.363-0.618). The number of MH's was not significantly different among various vasculopathies. Foci on SWI improved in two patients following liver transplantation. Conclusion SWI-positive foci outside of the basal ganglia (presumed MH's) are present in nearly half of AHE patients, but do not portend outcome. Regions with the most observed MH's were the periventricular white matter, cortical gray matter, and subcortical white matter.",
keywords = "Acute hepatic encephalopathy, Microhemorrhage, Susceptibility weighted imaging",
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T1 - Delineation of microhemorrhage in acute hepatic encephalopathy using susceptibility-weighted imaging

AU - Benson, John C.

AU - Payabvash, Seyedmehdi

AU - Thalken, Gregory L.

AU - Alonso, Juli

AU - Rykken, Jeffrey

AU - Ott, Frederick

AU - McKinney, Alexander M.

PY - 2016/3/1

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N2 - Introduction Microhemorrhages (MH's) in patients with acute hepatic encephalopathy (AHE) have scarcely been described. This study set out to assess if MH's occur in characteristic locations and frequency in patients with AHE superimposed on chronic liver failure, and to determine if such findings correlate with the clinical and MRI severity. Materials and methods Over a 4.5-year period, AHE patients with SWI MRI were included. The maximum plasma ammonia level (PAL), number and location of "frank" hemorrhages (>5 mm size) or MH's (<5 mm) on SWI, and severity of DWI and FLAIR were recorded. Susceptibility foci in the basal ganglia were disregarded, as those changes might represent common mineralization. The presence of MH's was correlated with the MRI and clinical severity. Results Punctate MH foci were found in 18/38 (47.4%) patients. The most common locations were periventricular white matter (6/38 patients, 15.8%) and cerebral cortex (5/38, 13.2%). Of 47 MH's, only a tiny minority (8.5%) occurred in regions of abnormality on FLAIR or DWI. Both the MRI severity on FLAIR (r = 0.420, p = 0.013) and DWI (r = 0.320, p = 0.045) mildly correlated with clinical outcome, but the correlation was not significant after Bonferroni correction. No significant correlation was found between the number of MH's and the clinical score, clinical outcome, FLAIR severity, or DWI severity (range r = -0.083-0.152, p = 0.363-0.618). The number of MH's was not significantly different among various vasculopathies. Foci on SWI improved in two patients following liver transplantation. Conclusion SWI-positive foci outside of the basal ganglia (presumed MH's) are present in nearly half of AHE patients, but do not portend outcome. Regions with the most observed MH's were the periventricular white matter, cortical gray matter, and subcortical white matter.

AB - Introduction Microhemorrhages (MH's) in patients with acute hepatic encephalopathy (AHE) have scarcely been described. This study set out to assess if MH's occur in characteristic locations and frequency in patients with AHE superimposed on chronic liver failure, and to determine if such findings correlate with the clinical and MRI severity. Materials and methods Over a 4.5-year period, AHE patients with SWI MRI were included. The maximum plasma ammonia level (PAL), number and location of "frank" hemorrhages (>5 mm size) or MH's (<5 mm) on SWI, and severity of DWI and FLAIR were recorded. Susceptibility foci in the basal ganglia were disregarded, as those changes might represent common mineralization. The presence of MH's was correlated with the MRI and clinical severity. Results Punctate MH foci were found in 18/38 (47.4%) patients. The most common locations were periventricular white matter (6/38 patients, 15.8%) and cerebral cortex (5/38, 13.2%). Of 47 MH's, only a tiny minority (8.5%) occurred in regions of abnormality on FLAIR or DWI. Both the MRI severity on FLAIR (r = 0.420, p = 0.013) and DWI (r = 0.320, p = 0.045) mildly correlated with clinical outcome, but the correlation was not significant after Bonferroni correction. No significant correlation was found between the number of MH's and the clinical score, clinical outcome, FLAIR severity, or DWI severity (range r = -0.083-0.152, p = 0.363-0.618). The number of MH's was not significantly different among various vasculopathies. Foci on SWI improved in two patients following liver transplantation. Conclusion SWI-positive foci outside of the basal ganglia (presumed MH's) are present in nearly half of AHE patients, but do not portend outcome. Regions with the most observed MH's were the periventricular white matter, cortical gray matter, and subcortical white matter.

KW - Acute hepatic encephalopathy

KW - Microhemorrhage

KW - Susceptibility weighted imaging

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