Metabolic Changes of Anterior Cingulate Cortex in Patients with Hepatic Cirrhosis: A Magnetic Resonance Spectroscopy Study

Aim: The anterior cingulate cortex (ACC) plays an important role in cognitive functions. The purpose of this study is to compare metabolite concentrations in the ACC of cirrhotic patients with normal controls, and to correlate metabolite changes with Child-Pugh class and with severity of hepatic encephalopathy (HE).

Methods: Fifty-two cirrhotic patients and 30 healthy volunteers were included in this study. All subjects performed the number connection test type A (NCT-A) and digital symbol test (DST) before multiple resonance (MR) examinations. Single-voxel proton MR spectroscopy (MRS) data in the ACC were acquired on a 1.5-T scanner. The ratios of all metabolites to creatine and phosphocreatine (Cr) were obtained. Statistical analysis was performed to evaluate the difference between control and cirrhotic patients, with respect to metabolite ratios. The correlation between metabolite ratios and Child-Pugh scale, severity of HE, venous ammonia and neuropsychiatric test results was analyzed.

Results: The ratios of choline (Cho)/Cr and myo-inositol (mIns)/Cr were significantly lower, and the ratio of glutamine- glutamate (Glx)/Cr was significantly higher in cirrhotic patients than those in controls (P < 0.001). mIns/Cr correlated negatively with Child-Pugh scale (r = -0.496, P < 0.001) and HE degree (r = -0.313, P < 0.05). Venous ammonia had a significant correlation with Cho/Cr (r = -0.329, P < 0.05) and mIns/Cr (r = -0.347, P < 0.05). No statistical correlation between metabolite ratios and neuropsychological tests was found for cirrhotic patients, but mIns/Cr did have a statistical correlation with NCT-A (r = -0.270, P < 0.05) and DST (r = 0.463, P < 0.001) when all subjects were included in the analysis.

Conclusion: Significant metabolite changes were seen in the ACC in cirrhotic patients. Of the metabolites examined, the mIns/Cr level in the ACC was most closely associated with the severity of HE and hepatic functional reserve reflected by Child-Pugh scale.