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<meta name="DC.Title" content="Brain MR Imaging and 1H-MR Spectroscopy Changes in Patients with Extrahepatic Portal Vein Obstruction from Early Childhood to Adulthood" />
<meta name="DC.Identifier" content="10.3174/ajnr.A2045" />
<meta name="DC.Date" content="2010-08-01" />
<meta name="DC.Publisher" content="American Journal of Neuroradiology" />
<meta name="DC.Rights" content="Copyright © American Society of Neuroradiology. Indicates open access to non-subscribers at www.ajnr.org" />
<meta name="DC.AccessRights" content="open-access" />
<meta name="DC.Description" content="BACKGROUND AND PURPOSE: MR imaging and 1H-MR spectroscopy changes are well reported in cirrhotic patients, whereas they are inadequately reported in EHPVO. The aim of this study was to investigate age-related changes in brain MR imaging and metabolite profile in EHPVO with and without MHE and to explore any correlation of imaging and 1H-MR spectroscopy parameters with blood ammonia.

MATERIALS AND METHODS: Sixty-three patients with EHPVO (children, 7–12 years [ n = 22], adolescents, 13–18 years [ n = 15] and adults, 19–41 years [ n = 26]) and 47 healthy age/sex-matched volunteers were studied. Neuropsychological tests, MR imaging, 1H-MR spectroscopy, and blood ammonia estimation were performed in all subjects.

RESULTS: Of 63 EHPVO patients, 25 (40%) who had MHE showed significantly increased MD, Glx, and blood ammonia in all 3 age groups; however, myo-inositol was significantly lower only in adults when compared with controls. MD positively correlated with blood ammonia and Glx in all age groups. Brain choline levels were normal in all patients with different age groups.

CONCLUSIONS: Increases in brain MD, Glx, and blood ammonia were associated with MHE in all age groups. Normal brain choline in EHPVO signifies healthy liver and may serve as a diagnostic marker for its differentiation from cirrhosis-induced encephalopathy. Significant decrease of myo-inositol in adults is probably due to cellular osmoregulation secondary to long-standing hyperammonemia.

ALIC
:   anterior limb of internal capsule
ALT
:   alanine transaminase
ANOVA
:   analysis of variance
AST
:   aspartate transaminase
BA
:   blood ammonia
CG
:   cingulate gyrus
CN
:   caudate nucleus
DTI
:   diffusion tensor imaging
EHPVO
:   extrahepatic portal vein obstruction
FA
:   fractional anisotropy
FWM
:   frontal white matter
Glx
:   glutamine/glutamate
GP
:   globus pallidus
1H-MRS
:   1H-MR spectroscopy
MD
:   mean diffusivity
MHE
:   minimal hepatic encephalopathy
NAA
:   N -acetylaspartate
NS
:   not significant
OWM
:   occipital white matter
P
:   putamen
PLIC
:   posterior limb of internal capsule
PT
:   prothrombin time
S
:   significant
SB
:   serum bilirubin
Sp
:   splenium
T
:   thalamus" />
<meta name="DC.Contributor" content="S.K. Yadav" />
<meta name="DC.Contributor" content="S. Saksena" />
<meta name="DC.Contributor" content="Anshu Srivastava" />
<meta name="DC.Contributor" content="Arti Srivastava" />
<meta name="DC.Contributor" content="V.A. Saraswat" />
<meta name="DC.Contributor" content="M.A. Thomas" />
<meta name="DC.Contributor" content="R.K.S. Rathore" />
<meta name="DC.Contributor" content="R.K. Gupta" />
<meta name="article:published_time" content="2010-08-01" />
<meta name="article:section" content="Brain" />
<meta name="citation_title" content="Brain MR Imaging and 1H-MR Spectroscopy Changes in Patients with Extrahepatic Portal Vein Obstruction from Early Childhood to Adulthood" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE: &lt;/h3&gt;
&lt;p&gt;MR imaging and &lt;sup&gt;1&lt;/sup&gt;H-MR spectroscopy changes are well reported in cirrhotic patients, whereas they are inadequately reported in EHPVO. The aim of this study was to investigate age-related changes in brain MR imaging and metabolite profile in EHPVO with and without MHE and to explore any correlation of imaging and &lt;sup&gt;1&lt;/sup&gt;H-MR spectroscopy parameters with blood ammonia.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS: &lt;/h3&gt;
&lt;p&gt;Sixty-three patients with EHPVO (children, 7–12 years [&lt;i&gt;n&lt;/i&gt; = 22], adolescents, 13–18 years [&lt;i&gt;n&lt;/i&gt; = 15] and adults, 19–41 years [&lt;i&gt;n&lt;/i&gt; = 26]) and 47 healthy age/sex-matched volunteers were studied. Neuropsychological tests, MR imaging, &lt;sup&gt;1&lt;/sup&gt;H-MR spectroscopy, and blood ammonia estimation were performed in all subjects.&lt;/p&gt;&lt;h3&gt;RESULTS: &lt;/h3&gt;
&lt;p&gt;Of 63 EHPVO patients, 25 (40%) who had MHE showed significantly increased MD, Glx, and blood ammonia in all 3 age groups; however, myo-inositol was significantly lower only in adults when compared with controls. MD positively correlated with blood ammonia and Glx in all age groups. Brain choline levels were normal in all patients with different age groups.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS: &lt;/h3&gt;
&lt;p&gt;Increases in brain MD, Glx, and blood ammonia were associated with MHE in all age groups. Normal brain choline in EHPVO signifies healthy liver and may serve as a diagnostic marker for its differentiation from cirrhosis-induced encephalopathy. Significant decrease of myo-inositol in adults is probably due to cellular osmoregulation secondary to long-standing hyperammonemia.&lt;/p&gt;" />
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<meta name="twitter:title" content="Brain MR Imaging and 1H-MR Spectroscopy Changes in Patients with Extrahepatic Portal Vein Obstruction from Early Childhood to Adulthood" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: MR imaging and 1H-MR spectroscopy changes are well reported in cirrhotic patients, whereas they are inadequately reported in EHPVO. The aim of this study was to investigate age-related changes in brain MR imaging and metabolite profile in EHPVO with and without MHE and to explore any correlation of imaging and 1H-MR spectroscopy parameters with blood ammonia.

MATERIALS AND METHODS: Sixty-three patients with EHPVO (children, 7–12 years [ n = 22], adolescents, 13–18 years [ n = 15] and adults, 19–41 years [ n = 26]) and 47 healthy age/sex-matched volunteers were studied. Neuropsychological tests, MR imaging, 1H-MR spectroscopy, and blood ammonia estimation were performed in all subjects.

RESULTS: Of 63 EHPVO patients, 25 (40%) who had MHE showed significantly increased MD, Glx, and blood ammonia in all 3 age groups; however, myo-inositol was significantly lower only in adults when compared with controls. MD positively correlated with blood ammonia and Glx in all age groups. Brain choline levels were normal in all patients with different age groups.

CONCLUSIONS: Increases in brain MD, Glx, and blood ammonia were associated with MHE in all age groups. Normal brain choline in EHPVO signifies healthy liver and may serve as a diagnostic marker for its differentiation from cirrhosis-induced encephalopathy. Significant decrease of myo-inositol in adults is probably due to cellular osmoregulation secondary to long-standing hyperammonemia.

ALIC
:   anterior limb of internal capsule
ALT
:   alanine transaminase
ANOVA
:   analysis of variance
AST
:   aspartate transaminase
BA
:   blood ammonia
CG
:   cingulate gyrus
CN
:   caudate nucleus
DTI
:   diffusion tensor imaging
EHPVO
:   extrahepatic portal vein obstruction
FA
:   fractional anisotropy
FWM
:   frontal white matter
Glx
:   glutamine/glutamate
GP
:   globus pallidus
1H-MRS
:   1H-MR spectroscopy
MD
:   mean diffusivity
MHE
:   minimal hepatic encephalopathy
NAA
:   N -acetylaspartate
NS
:   not significant
OWM
:   occipital white matter
P
:   putamen
PLIC
:   posterior limb of internal capsule
PT
:   prothrombin time
S
:   significant
SB
:   serum bilirubin
Sp
:   splenium
T
:   thalamus" />
<meta name="og-title" property="og:title" content="Brain MR Imaging and 1H-MR Spectroscopy Changes in Patients with Extrahepatic Portal Vein Obstruction from Early Childhood to Adulthood " />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/31/7/1337" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: MR imaging and 1H-MR spectroscopy changes are well reported in cirrhotic patients, whereas they are inadequately reported in EHPVO. The aim of this study was to investigate age-related changes in brain MR imaging and metabolite profile in EHPVO with and without MHE and to explore any correlation of imaging and 1H-MR spectroscopy parameters with blood ammonia.

MATERIALS AND METHODS: Sixty-three patients with EHPVO (children, 7–12 years [ n = 22], adolescents, 13–18 years [ n = 15] and adults, 19–41 years [ n = 26]) and 47 healthy age/sex-matched volunteers were studied. Neuropsychological tests, MR imaging, 1H-MR spectroscopy, and blood ammonia estimation were performed in all subjects.

RESULTS: Of 63 EHPVO patients, 25 (40%) who had MHE showed significantly increased MD, Glx, and blood ammonia in all 3 age groups; however, myo-inositol was significantly lower only in adults when compared with controls. MD positively correlated with blood ammonia and Glx in all age groups. Brain choline levels were normal in all patients with different age groups.

CONCLUSIONS: Increases in brain MD, Glx, and blood ammonia were associated with MHE in all age groups. Normal brain choline in EHPVO signifies healthy liver and may serve as a diagnostic marker for its differentiation from cirrhosis-induced encephalopathy. Significant decrease of myo-inositol in adults is probably due to cellular osmoregulation secondary to long-standing hyperammonemia.

ALIC
:   anterior limb of internal capsule
ALT
:   alanine transaminase
ANOVA
:   analysis of variance
AST
:   aspartate transaminase
BA
:   blood ammonia
CG
:   cingulate gyrus
CN
:   caudate nucleus
DTI
:   diffusion tensor imaging
EHPVO
:   extrahepatic portal vein obstruction
FA
:   fractional anisotropy
FWM
:   frontal white matter
Glx
:   glutamine/glutamate
GP
:   globus pallidus
1H-MRS
:   1H-MR spectroscopy
MD
:   mean diffusivity
MHE
:   minimal hepatic encephalopathy
NAA
:   N -acetylaspartate
NS
:   not significant
OWM
:   occipital white matter
P
:   putamen
PLIC
:   posterior limb of internal capsule
PT
:   prothrombin time
S
:   significant
SB
:   serum bilirubin
Sp
:   splenium
T
:   thalamus" />
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      <h1 class="highwire-cite-title" id="page-title">Brain MR Imaging and <sup>1</sup>H-MR Spectroscopy Changes in Patients with Extrahepatic Portal Vein Obstruction from Early Childhood to Adulthood </h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">S.K. Yadav</span>, <span class="highwire-citation-author" data-delta="1">S. Saksena</span>, <span class="highwire-citation-author" data-delta="2">Anshu Srivastava</span>, <span class="highwire-citation-author" data-delta="3">Arti Srivastava</span>, <span class="highwire-citation-author" data-delta="4">V.A. Saraswat</span>, <span class="highwire-citation-author" data-delta="5">M.A. Thomas</span>, <span class="highwire-citation-author" data-delta="6">R.K.S. Rathore</span> and <span class="highwire-citation-author" data-delta="7">R.K. Gupta</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">August 2010,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">31 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(7) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">1337-1342; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A2045 </span></div>
  
  
  
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<div id="hw-article-author-popups-top-node-9945--897201213" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">S.K. Yadav </div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&amp;gs_type=author&amp;author%5B0%5D=S.K.%2BYadav%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Yadav%20S&amp;link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AS.K.%2BYadav%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">S. 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    <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div xmlns:xhtml="http://www.w3.org/1999/xhtml" class="contributors"><ol class="contributor-list" id="contrib-group-1"><li class="contributor" id="contrib-1"><span class="name">S.K. Yadav</span><a id="xref-aff-1-1" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-2"><span class="name">S. Saksena</span><a id="xref-aff-1-2" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-3"><span class="name">Anshu Srivastava</span><a id="xref-aff-2-1" class="xref-aff" href="#aff-2">b</a>, </li><li class="contributor" id="contrib-4"><span class="name">Arti Srivastava</span><a id="xref-aff-1-3" class="xref-aff" href="#aff-1">a</a>, </li><li class="contributor" id="contrib-5"><span class="name">V.A. Saraswat</span><a id="xref-aff-3-1" class="xref-aff" href="#aff-3">c</a>, </li><li class="contributor" id="contrib-6"><span class="name">M.A. Thomas</span><a id="xref-aff-5-1" class="xref-aff" href="#aff-5">e</a>, </li><li class="contributor" id="contrib-7"><span class="name">R.K.S. Rathore</span><a id="xref-aff-4-1" class="xref-aff" href="#aff-4">d</a> and </li><li class="last" id="contrib-8"><span class="name">R.K. Gupta</span><a id="xref-aff-1-4" class="xref-aff" href="#aff-1">a</a></li></ol><ol class="affiliation-list"><li class="aff"><a id="aff-1" name="aff-1"></a><address><sup>a</sup>From the Departments of Radiodiagnosis (S.K.Y., S.S., Ar.S., R.K.G.)</address></li><li class="aff"><a id="aff-2" name="aff-2"></a><address><sup>b</sup>Pediatric Gastroenterology (An.S.)</address></li><li class="aff"><a id="aff-3" name="aff-3"></a><address><sup>c</sup>Gastroenterology (V.A.S.)</address></li><li class="aff"><a id="aff-4" name="aff-4"></a><address><sup>d</sup>Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India; Department of Mathematics and Statistics (R.K.S.R.), Indian Institute of Technology, Kanpur, Uttar Pradesh, India</address></li><li class="aff"><a id="aff-5" name="aff-5"></a><address><sup>e</sup>Department of Radiological Sciences (M.A.T.), David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California. </address></li></ol><ol class="corresp-list"><li class="corresp" id="corresp-1">Please address correspondence to Dr. Rakesh K. Gupta, MD, 
<span class="addr-line">Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Rd, Lucknow, UP, India, 226014</span>; 
e-mail: <span class="em-link"><span class="em-addr">rgupta{at}sgpgi.ac.in</span></span>
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