The role of brain magnetic resonance spectroscopy in assessment of patients with minimal hepatic encephalopathy

Background: It appears that mild and hidden Hepatic Encephalopathy (HE) is present in up to 50% of patients with chronic liver disease. Tools that can predict when HE episodes would occur may enable early detection and clinically relevant preventative treatment. The brain's magnetic resonance spectroscopy (MRS) is considered a useful technique for providing a range of structural and functional assessments. Objective: To evaluate the role of brain magnetic resonance spectroscopy in assessment of metabolic changes in patients with chronic liver disease and minimal hepatic encephalopathy for better diagnosis and thus prevention of decline in cognitive functions and health related quality of life. Methods: This is prospective study included 29patients (age ranging from 19to70 years) recruited from Gastroenterology and Hepatology Department to Radiodiagnosis Department of National Hepatology and Tropical Medicine Research Institute. All patients had minimal hepatic encephalopathy. Each patient was subjected to full history taking, routine laboratory investigations. Clinical examination includes neurological examination, MRI&MRS of the brain with detection of the levels of metabolites. Results: The study showed that the mean age of the studied group was 60.79±9.26 years. Regarding sex 51.7% of the studied group were males and 48.3% of them were females.glutamax(GLX)was positive in 65.5% of the studied group, choline was positive in 13.8%, NAA was positive in 13.8%, manganese was positive in 41.4% of the studied group, and cortical edema was positive in 65.5% of the studied group. Conclusion:MR spectroscopy is a promising noninvasive technique that can trace brain changes associated with minimal hepatic encephalopathy, such as the manganese, glutamax and other depositions in addition to the development of cerebral edema that lead to impairment in brain function.