Motor Cortex Mapping in Patients With Hepatic Myelopathy After Transjugular Intrahepatic Portosystemic Shunt.

Abstract

RATIONALE AND OBJECTIVES:

As a special movement disorder, hepatic myelopathy (HM) is characterized by spastic paraperesis and may be secondary to transjugular intrahepatic portosystemic shunt (TIPS). The prediction and diagnosis of HM is difficult due to largely unknown neuropathological underpinnings and a lack of specific biomarkers. We aimed to delve into the alterations in motor system of HM patients' brain and their potential clinical implication.

MATERIAL AND METHODS:

Twenty-three patients with HM and 23 without HM after TIPS and 24 demographically matched healthy controls were enrolled. High-spatial-resolution structural imaging and functional data at rest were acquired. Motor areas were included as seed regions for functional connectivity analysis. Then, we performed brain volume analysis.

RESULTS:

We found decreased right supplementary motor area (SMA)-seeded functional connectivity with bilateral insula, thalamus and midbrain, left cerebellum and middle temporal gyrus, and right middle cingulate gyrus in HM compared to non-HM patients (p < 0.001). The right insula revealed decreased volume (p < 0.001), and white matter volume reduced in the right corona radiata beneath the right SMA (p < 0.001) in HM relative to non-HM patients. Furthermore, the strength of right SMA-seeded connectivity with insula was positively correlated with folic acid level in HM patients (r = 0.60, p = 0.03), showing an accuracy of 0.87 to distinguish HM from non-HM.

CONCLUSION:

Our study demonstrates the HM-specific dysconnectivity with an anatomical basis, and its correlation with laboratory findings and diagnostic value. Detecting these abnormalities might help to predict and diagnose post-TIPS HM.

• Authors: Long-Biao Cui, Shuyao Ren, Yi-Bin Xi, Ling-Li Zeng, Gang Chen, Kang Liu, Tianlei Yu, Chuangye He, Wengang Guo, Zhanxin Yin, Zhengyu Wang, Jing Niu, Bohan Luo, Dewen Hu, Guohong Han, Hong Yin
• Journal: Academic radiology (Acad Radiol) Vol. 26 Issue 5 Pg. e38-e46 (05 2019) ISSN: 1878-4046 [Electronic] United States
• PMID: 30076082 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2018 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Chemical References

• Biomarkers

Topics

• Biomarkers (metabolism)
• Brain (pathology, physiopathology)
• Brain Diseases (pathology, physiopathology)
• Brain Mapping (methods)
• Case-Control Studies
• Female
• Humans
• Liver Cirrhosis (pathology, physiopathology)
• Male
• Middle Aged
• Motor Cortex (pathology, physiopathology)
• Organ Size (physiology)
• Paraparesis, Spastic (pathology, physiopathology)
• Portasystemic Shunt, Transjugular Intrahepatic
• Postoperative Complications (pathology, physiopathology)
• Spinal Cord Diseases (pathology, physiopathology)
• White Matter (pathology, physiopathology)