Brain metabolism in minimal hepatic encephalopathy assessed by 3.0-Tesla magnetic resonance spectroscopy

Aim To examine whether the brain exhibits metabolic disorder prior to overt hepatic encephalopathy in patients with liver cirrhosis (LC), the intracerebral glutamine and myo‐inositol levels were determined using 3.0‐Tesla (T)1H (proton) magnetic resonance spectroscopy (MRS). Methods We tested 21 LC patients, including seven patients with minimal hepatic encephalopathy (MHE). Results No significant differences were noted between the two patient groups in terms of the severity of LC, levels of blood ammonia or levels of blood or liver enzymes. In the MHE group, the levels of brain glutamine were significantly higher than those in the non‐MHE group, whereas the levels of brain myo‐inositol were significantly lower. This demonstrated that MHE patients were already exhibiting metabolic disorder in the brain, similar to those observed during overt hepatic encephalopathy. Conclusion A quantitative analysis of this phenomenon using MRS may contribute to an early and objective diagnosis of MHE.