Dynamic changes of intrinsic brain activity in cirrhotic patients after transjugular intrahepatic portosystemic shunt: a resting-state FMRI study

Rongfeng Qi; Long Jiang Zhang; Jianhui Zhong; Shengyong Wu; Zhiqiang Zhang; Yuan Zhong; Ling Ni; Gang Zheng; Qing Jiao; Xingjiang Wu; Xinxin Fan; Yijun Liu; Guangming Lu

doi:10.1371/journal.pone.0046681

Dynamic changes of intrinsic brain activity in cirrhotic patients after transjugular intrahepatic portosystemic shunt: a resting-state FMRI study

PLoS One. 2012;7(10):e46681. doi: 10.1371/journal.pone.0046681. Epub 2012 Oct 2.

Authors

Rongfeng Qi¹, Long Jiang Zhang, Jianhui Zhong, Shengyong Wu, Zhiqiang Zhang, Yuan Zhong, Ling Ni, Gang Zheng, Qing Jiao, Xingjiang Wu, Xinxin Fan, Yijun Liu, Guangming Lu

Affiliation

¹ Department of Medical Imaging, Jinling Hospital, Clinical School of Medical College, Nanjing University, Nanjing, Jiangsu, China.

Abstract

Purpose: The majority of cirrhotic patients who underwent transjugular intrahepatic portosystemic shunt (TIPS) experienced the first post-TIPS hepatic encephalopathy (HE) episode within the first three months after TIPS insertion. However, so far, little is known about the exact neuro-pathophysiological mechanism of TIPS's effects on brain function. We aimed to investigate the dynamics of brain function alteration of post-TIPS patients using resting-state functional MRI (rs-fMRI).

Materials and methods: Sixteen cirrhotic patients who were scheduled for TIPS and 16 healthy controls were included in the rs-fMRI scans. Ten patients repeated the MRI study in a median 8-day follow-up interval following TIPS and seven in a median 3-month follow-up. The amplitude of low frequency fluctuation (ALFF), an index reflecting the spontaneous brain activity, was compared between patients before TIPS and healthy controls as well as patients pre- and post-TIPS.

Results: Compared with healthy controls, patients showed decreased ALFF in frontal and parietal regions and increased ALFF in insula. Patients who underwent the median 8-day follow-up fMRI examinations showed decreased ALFF in posterior cingulate cortex (PCC)/precuneus and increased ALFF in anterior cingulate cortex (ACC). Of 10 patients in this group, 9 had moderate to large increase rate of ALFF value (>20%, mean 49.19%) in ACC, while only one patient with the smallest increase rate of ALFF value (<10%) in ACC, who experienced three episodes of overt HE during the 3-month follow-up. In the median 3-month follow up observation, patients displayed persistently decreased ALFF in PCC, ACC and medial prefrontal cortex (MPFC), while no increased regional ALFF was observed.

Conclusion: TIPS insertion alters cirrhotic patients' ALFF patterns in the resting state, which may imply different short-term and moderate-term effects on cirrhotic patients, i.e., both impairment and compensatory mechanism of brain functions in peri-TIPS and continuous impairment of brain function 3 months following TIPS.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Brain / physiology*
Brain / physiopathology*
Female
Humans
Liver Cirrhosis / surgery*
Magnetic Resonance Imaging / methods*
Male
Middle Aged
Portasystemic Shunt, Transjugular Intrahepatic / adverse effects*

Grants and funding

This work was supported by the grants from the Natural Scientific Foundation of China (grant no. 30700194 and no. 81230032 for Long Jiang Zhang, grant no. 30800264 for Zhiqiang Zhang, grant no. 30971019 for Qing Jiao, and grant no. 81101039 for Gang Zheng), and Chinese Key Program (grant no. BWS11J063 and no. 10z026 for Guangming Lu). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.