Reduced Cortical Complexity in Cirrhotic Patients with Minimal Hepatic Encephalopathy

Overview

Journal Neural Plast

Specialty Neurology

Date 2020 Apr 8

PMID 32256557

Citations 8

Authors

Qiu-Feng Chen

Xiao-Hong Zhang

Tian-Xiu Zou

Nao-Xin Huang

Hua-Jun Chen

Affiliations

Soon will be listed here.

Abstract

Purpose: Gray matter volume loss, regional cortical thinning, and local gyrification index alteration have been documented in minimal hepatic encephalopathy (MHE). Fractal dimension (FD), another morphological parameter, has been widely used to describe structural complexity alterations in neurological or psychiatric disease. Here, we conducted the first study to investigate FD alterations in MHE.

Methods And Materials: We performed high-resolution structural magnetic resonance imaging on cirrhotic patients with MHE ( = 20) and healthy controls ( = 21). We evaluated their cognitive performance using the psychometric hepatic encephalopathy score (PHES). The regional FD value was calculated by Computational Anatomy Toolbox (CAT12) and compared between groups. We further estimated the association between patients' cognitive performance and FD values.

Results: MHE patients presented significantly decreased FD values in the left precuneus, left supramarginal gyrus, right caudal anterior cingulate cortex, right isthmus cingulate cortex, right insula, bilateral pericalcarine cortex, and bilateral paracentral cortex compared to normal controls. In addition, the FD values in the right isthmus cingulate cortex and right insula were shown to be positively correlated with patients' cognitive performance.

Conclusion: Aberrant cortical complexity is an additional characteristic of MHE, and FD analysis may provide novel insight into the neurobiological basis of cognitive dysfunction in MHE.

Citing Articles

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Cortical morphological changes in multiple sclerosis patients: a study of cortical thickness, sulcal depth, and local gyrification index.

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Decreased Brain Structural Network Connectivity in Patients with Mild Cognitive Impairment: A Novel Fractal Dimension Analysis.

Lau C, Yeh J, Tsai Y, Hsiao C, Wu Y, Jao C Brain Sci. 2023; 13(1).

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Reduced cortical complexity in patients with end-stage kidney disease prior to dialysis initiation.

Yuan H, Li H, Mu J, Gu W, Zhu X, Gao L Front Neurosci. 2022; 16:971010.

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Altered dynamic spontaneous neural activity in minimal hepatic encephalopathy.

Guo J, Shi J, Dong Q, Cao Y, Li D, Chen H Front Neurol. 2022; 13:963551.

PMID: 36061995 PMC: 9439282. DOI: 10.3389/fneur.2022.963551.

References

King R, Brown B, Hwang M, Jeon T, George A . Fractal dimension analysis of the cortical ribbon in mild Alzheimer's disease. Neuroimage. 2010; 53(2):471-9. PMC: 2942777. DOI: 10.1016/j.neuroimage.2010.06.050. View

Davis K, Taylor K, Hutchison W, Dostrovsky J, McAndrews M, Richter E . Human anterior cingulate cortex neurons encode cognitive and emotional demands. J Neurosci. 2005; 25(37):8402-6. PMC: 6725669. DOI: 10.1523/JNEUROSCI.2315-05.2005. View

Shawcross D, Dunk A, Jalan R, Kircheis G, de Knegt R, Laleman W . How to diagnose and manage hepatic encephalopathy: a consensus statement on roles and responsibilities beyond the liver specialist. Eur J Gastroenterol Hepatol. 2015; 28(2):146-52. PMC: 4885589. DOI: 10.1097/MEG.0000000000000529. View

Srivastava A, Chaturvedi S, Gupta R, Malik R, Mathias A, Jagannathan N . Minimal hepatic encephalopathy in children with chronic liver disease: Prevalence, pathogenesis and magnetic resonance-based diagnosis. J Hepatol. 2016; 66(3):528-536. DOI: 10.1016/j.jhep.2016.10.026. View

Rajagopalan V, Das A, Zhang L, Hillary F, Wylie G, Yue G . Fractal dimension brain morphometry: a novel approach to quantify white matter in traumatic brain injury. Brain Imaging Behav. 2018; 13(4):914-924. DOI: 10.1007/s11682-018-9892-2. View

Ni L, Qi R, Zhang L, Zhong J, Zheng G, Zhang Z . Altered regional homogeneity in the development of minimal hepatic encephalopathy: a resting-state functional MRI study. PLoS One. 2012; 7(7):e42016. PMC: 3404989. DOI: 10.1371/journal.pone.0042016. View

Chen H, Liu P, Chen Q, Shi H . Brain Microstructural Abnormalities in Patients With Cirrhosis Without Overt Hepatic Encephalopathy: A Voxel-Based Diffusion Kurtosis Imaging Study. AJR Am J Roentgenol. 2017; 209(5):1128-1135. DOI: 10.2214/AJR.17.17827. View

Reishofer G, Studencnik F, Koschutnig K, Deutschmann H, Ahammer H, Wood G . Age is reflected in the Fractal Dimensionality of MRI Diffusion Based Tractography. Sci Rep. 2018; 8(1):5431. PMC: 5883031. DOI: 10.1038/s41598-018-23769-6. View

Chen Q, Zou T, Yang Z, Chen H . Identification of patients with and without minimal hepatic encephalopathy based on gray matter volumetry using a support vector machine learning algorithm. Sci Rep. 2020; 10(1):2490. PMC: 7016173. DOI: 10.1038/s41598-020-59433-1. View

10.

Madan C, Kensinger E . Age-related differences in the structural complexity of subcortical and ventricular structures. Neurobiol Aging. 2016; 50:87-95. PMC: 5209263. DOI: 10.1016/j.neurobiolaging.2016.10.023. View

11.

Lv X, Qiu Y, Tian J, Xie C, Han L, Su H . Abnormal regional homogeneity of resting-state brain activity in patients with HBV-related cirrhosis without overt hepatic encephalopathy. Liver Int. 2013; 33(3):375-83. DOI: 10.1111/liv.12096. View

12.

Zhang L, Lu G, Yin J, Qi J . Metabolic changes of anterior cingulate cortex in patients with hepatic cirrhosis: A magnetic resonance spectroscopy study. Hepatol Res. 2010; 40(8):777-85. DOI: 10.1111/j.1872-034X.2010.00681.x. View

13.

Chen H, Chen Q, Liu J, Shi H . Aberrant salience network and its functional coupling with default and executive networks in minimal hepatic encephalopathy: a resting-state fMRI study. Sci Rep. 2016; 6:27092. PMC: 4890427. DOI: 10.1038/srep27092. View

14.

Zhao G, Denisova K, Sehatpour P, Long J, Gui W, Qiao J . Fractal Dimension Analysis of Subcortical Gray Matter Structures in Schizophrenia. PLoS One. 2016; 11(5):e0155415. PMC: 4866699. DOI: 10.1371/journal.pone.0155415. View

15.

Iwasa M, Mifuji-Moroka R, Kuroda M, Moroka H, Fujita N, Kobayashi Y . Regional reduction in gray and white matter volume in brains of cirrhotic patients: voxel-based analysis of MRI. Metab Brain Dis. 2012; 27(4):551-7. DOI: 10.1007/s11011-012-9314-x. View

16.

Garcia-Garcia R, Cruz-Gomez A, Mangas-Losada A, Urios A, Forn C, Escudero-Garcia D . Reduced resting state connectivity and gray matter volume correlate with cognitive impairment in minimal hepatic encephalopathy. PLoS One. 2017; 12(10):e0186463. PMC: 5638549. DOI: 10.1371/journal.pone.0186463. View

17.

Sun Q, Fan W, Ye J, Han P . Abnormal Regional Homogeneity and Functional Connectivity of Baseline Brain Activity in Hepatitis B Virus-Related Cirrhosis With and Without Minimal Hepatic Encephalopathy. Front Hum Neurosci. 2018; 12:245. PMC: 6024159. DOI: 10.3389/fnhum.2018.00245. View

18.

King R, George A, Jeon T, Hynan L, Youn T, Kennedy D . Characterization of Atrophic Changes in the Cerebral Cortex Using Fractal Dimensional Analysis. Brain Imaging Behav. 2011; 3(2):154-166. PMC: 2927230. DOI: 10.1007/s11682-008-9057-9. View

19.

Madan C, Kensinger E . Cortical complexity as a measure of age-related brain atrophy. Neuroimage. 2016; 134:617-629. PMC: 4945358. DOI: 10.1016/j.neuroimage.2016.04.029. View

20.

Bajaj J, Saeian K, Schubert C, Hafeezullah M, Franco J, Varma R . Minimal hepatic encephalopathy is associated with motor vehicle crashes: the reality beyond the driving test. Hepatology. 2009; 50(4):1175-83. PMC: 2757520. DOI: 10.1002/hep.23128. View