Subclinical hepatic encephalopathy: proton MR spectroscopic abnormalities

Radiology. 1994 Nov;193(2):457-63. doi: 10.1148/radiology.193.2.7972763.


Purpose: To determine whether hydrogen-1 magnetic resonance (MR) spectroscopy of the brain allows detection of subclinical hepatic encephalopathy (SCHE).

Materials and methods: In a double-blind study, overt hepatic encephalopathy (HE) and SCHE (defined with clinical and neuropsychiatric tests) were compared by means of H-1 MR spectroscopic criteria--reduction in cerebral myo-inositol (< 2 standard deviations [SDs] from normal) and choline (< 2 SDs from normal) with or without increased cerebral glutamine (> 1 SD from normal)--in 20 patients with cirrhosis.

Results: Concordance between MR spectroscopic and neuropsychiatric test results was 94% (kappa = 0.84). MR spectroscopy allowed diagnosis of SCHE in nine of nine patients (100%) and of HE in seven of eight (88%). Myo-inositol depletion alone had 80%-85% sensitivity for detection of HE and SCHE.

Conclusion: H-1 MR spectroscopy allows accurate diagnosis of SCHE, and the results suggest an important role for myo-inositol in psychomotor and visuopractic functions.

Publication types

  • Clinical Trial
  • Controlled Clinical Trial

MeSH terms

  • Adult
  • Brain Chemistry
  • Choline / analysis
  • Double-Blind Method
  • Female
  • Glutamine / analysis
  • Hepatic Encephalopathy / diagnosis*
  • Humans
  • Inositol / analysis
  • Liver Cirrhosis / complications
  • Liver Cirrhosis / metabolism
  • Magnetic Resonance Spectroscopy*
  • Male
  • Middle Aged
  • Neuropsychological Tests


  • Glutamine
  • Inositol
  • Choline