Regional differences in cerebral blood flow and cerebral ammonia metabolism in patients with cirrhosis
Clinical and histopathological findings hint at regional differences in the brain's sensitivity to metabolic changes in cirrhosis. The aim of the present study was to examine regional differences in cerebral ammonia metabolism in patients with cirrhosis and grade 0‐to‐I hepatic encephalopathy (...
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| Veröffentlicht in: | Hepatology (Baltimore, Md.) Md.), 2004-07, Vol.40 (1), p.73-79 |
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| container_title | Hepatology (Baltimore, Md.) |
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| creator | Ahl, Björn Weissenborn, Karin van den Hoff, Jörg Fischer‐Wasels, Daniela Köstler, Herbert Hecker, Hartmut Burchert, Wolfgang |
| description | Clinical and histopathological findings hint at regional differences in the brain's sensitivity to metabolic changes in cirrhosis. The aim of the present study was to examine regional differences in cerebral ammonia metabolism in patients with cirrhosis and grade 0‐to‐I hepatic encephalopathy (HE). 13N‐ammonia, 15O‐water positron emission tomography (PET) and magnetic resonance imaging (MRI) were performed. Quantitative values of cerebral blood flow (CBF) and the initial cerebral ammonia uptake rate (K1) were derived for several regions of interest from images of the desired parameters after interactive coregistration with the patients' MRI‐studies. CBF (mL/mL/min), K1 (mL/mL/min), and the ammonia extraction fraction (K1/CBF) showed marked regional variance with the highest levels in the thalamus, the lenticular nucleus, and the cerebellum. In conclusion, the regional differences in cerebral ammonia uptake correspond to the distribution of histopathological changes in the brain of patients with cirrhosis as well as clinical features of HE, characterized by signs of basal ganglia and cerebellar dysfunction with corresponding signs of functional impairment, especially of the frontal cortex and cingulate gyrus. (HEPATOLOGY 2004;40:73–79.) |
| doi_str_mv | 10.1002/hep.20290 |
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The aim of the present study was to examine regional differences in cerebral ammonia metabolism in patients with cirrhosis and grade 0‐to‐I hepatic encephalopathy (HE). 13N‐ammonia, 15O‐water positron emission tomography (PET) and magnetic resonance imaging (MRI) were performed. Quantitative values of cerebral blood flow (CBF) and the initial cerebral ammonia uptake rate (K1) were derived for several regions of interest from images of the desired parameters after interactive coregistration with the patients' MRI‐studies. CBF (mL/mL/min), K1 (mL/mL/min), and the ammonia extraction fraction (K1/CBF) showed marked regional variance with the highest levels in the thalamus, the lenticular nucleus, and the cerebellum. In conclusion, the regional differences in cerebral ammonia uptake correspond to the distribution of histopathological changes in the brain of patients with cirrhosis as well as clinical features of HE, characterized by signs of basal ganglia and cerebellar dysfunction with corresponding signs of functional impairment, especially of the frontal cortex and cingulate gyrus. (HEPATOLOGY 2004;40:73–79.)</description><identifier>ISSN: 0270-9139</identifier><identifier>EISSN: 1527-3350</identifier><identifier>DOI: 10.1002/hep.20290</identifier><identifier>PMID: 15239088</identifier><identifier>CODEN: HPTLD9</identifier><language>eng</language><publisher>Hoboken: Wiley Subscription Services, Inc., A Wiley Company</publisher><subject>Adult ; Aged ; Ammonia - pharmacokinetics ; Biological and medical sciences ; Brain - metabolism ; Cerebellum - metabolism ; Cerebrovascular Circulation ; Corpus Striatum - metabolism ; Female ; Gastroenterology. Liver. Pancreas. Abdomen ; Hepatic Encephalopathy - diagnosis ; Hepatic Encephalopathy - etiology ; Hepatic Encephalopathy - metabolism ; Hepatic Encephalopathy - physiopathology ; Humans ; Liver Cirrhosis - complications ; Liver. Biliary tract. Portal circulation. Exocrine pancreas ; Magnetic Resonance Imaging ; Male ; Medical sciences ; Middle Aged ; Other diseases. 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The aim of the present study was to examine regional differences in cerebral ammonia metabolism in patients with cirrhosis and grade 0‐to‐I hepatic encephalopathy (HE). 13N‐ammonia, 15O‐water positron emission tomography (PET) and magnetic resonance imaging (MRI) were performed. Quantitative values of cerebral blood flow (CBF) and the initial cerebral ammonia uptake rate (K1) were derived for several regions of interest from images of the desired parameters after interactive coregistration with the patients' MRI‐studies. CBF (mL/mL/min), K1 (mL/mL/min), and the ammonia extraction fraction (K1/CBF) showed marked regional variance with the highest levels in the thalamus, the lenticular nucleus, and the cerebellum. In conclusion, the regional differences in cerebral ammonia uptake correspond to the distribution of histopathological changes in the brain of patients with cirrhosis as well as clinical features of HE, characterized by signs of basal ganglia and cerebellar dysfunction with corresponding signs of functional impairment, especially of the frontal cortex and cingulate gyrus. (HEPATOLOGY 2004;40:73–79.)</description><subject>Adult</subject><subject>Aged</subject><subject>Ammonia - pharmacokinetics</subject><subject>Biological and medical sciences</subject><subject>Brain - metabolism</subject><subject>Cerebellum - metabolism</subject><subject>Cerebrovascular Circulation</subject><subject>Corpus Striatum - metabolism</subject><subject>Female</subject><subject>Gastroenterology. Liver. Pancreas. Abdomen</subject><subject>Hepatic Encephalopathy - diagnosis</subject><subject>Hepatic Encephalopathy - etiology</subject><subject>Hepatic Encephalopathy - metabolism</subject><subject>Hepatic Encephalopathy - physiopathology</subject><subject>Humans</subject><subject>Liver Cirrhosis - complications</subject><subject>Liver. Biliary tract. Portal circulation. Exocrine pancreas</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Other diseases. Semiology</subject><subject>Thalamus - metabolism</subject><subject>Tissue Distribution</subject><subject>Tomography, Emission-Computed</subject><issn>0270-9139</issn><issn>1527-3350</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2004</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10E1rGzEQBmBRGhrn49A_UPbSQg4bz-x6tdKxBCcOBBJCcl4k7ahW0a5caY3Jv69cG9JLThLDM-_Ay9hXhGsEqOZr2lxXUEn4xGbYVG1Z1w18ZjOoWigl1vKUnaX0GwDkohJf2GlGtQQhZsw-0y8XRuWL3llLkUZDqXBjYfJfxzzXPoS-sD7sCjX273M1DGF0qhhoUjp4l4b92kZNjsYpFTs3rQvjYlyH5NIFO7HKJ7o8vufs9Xb5crMqHx7v7m9-PpSmFhxK1GRr1D1iI1oN2NpKYcM5RyOgsUhAyA1vWimktYhccwCNCyWQk1yo-pz9OORuYvizpTR1g0uGvFcjhW3qclQrF8AzvDpAE0NKkWy3iW5Q8a1D6PaldrnU7l-p2X47hm71QP27PLaYwfcjUMkob6MajUv_OYlCtE1284PbOU9vH1_sVsunw-m_bluN7w</recordid><startdate>200407</startdate><enddate>200407</enddate><creator>Ahl, Björn</creator><creator>Weissenborn, Karin</creator><creator>van den Hoff, Jörg</creator><creator>Fischer‐Wasels, Daniela</creator><creator>Köstler, Herbert</creator><creator>Hecker, Hartmut</creator><creator>Burchert, Wolfgang</creator><general>Wiley Subscription Services, Inc., A Wiley Company</general><general>Wiley</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200407</creationdate><title>Regional differences in cerebral blood flow and cerebral ammonia metabolism in patients with cirrhosis</title><author>Ahl, Björn ; Weissenborn, Karin ; van den Hoff, Jörg ; Fischer‐Wasels, Daniela ; Köstler, Herbert ; Hecker, Hartmut ; Burchert, Wolfgang</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3860-1bef31bd11587b017f2a156661c805f1e0e16c657989ff116b600b14a816e94a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2004</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Ammonia - pharmacokinetics</topic><topic>Biological and medical sciences</topic><topic>Brain - metabolism</topic><topic>Cerebellum - metabolism</topic><topic>Cerebrovascular Circulation</topic><topic>Corpus Striatum - metabolism</topic><topic>Female</topic><topic>Gastroenterology. Liver. Pancreas. Abdomen</topic><topic>Hepatic Encephalopathy - diagnosis</topic><topic>Hepatic Encephalopathy - etiology</topic><topic>Hepatic Encephalopathy - metabolism</topic><topic>Hepatic Encephalopathy - physiopathology</topic><topic>Humans</topic><topic>Liver Cirrhosis - complications</topic><topic>Liver. Biliary tract. Portal circulation. Exocrine pancreas</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Other diseases. Semiology</topic><topic>Thalamus - metabolism</topic><topic>Tissue Distribution</topic><topic>Tomography, Emission-Computed</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ahl, Björn</creatorcontrib><creatorcontrib>Weissenborn, Karin</creatorcontrib><creatorcontrib>van den Hoff, Jörg</creatorcontrib><creatorcontrib>Fischer‐Wasels, Daniela</creatorcontrib><creatorcontrib>Köstler, Herbert</creatorcontrib><creatorcontrib>Hecker, Hartmut</creatorcontrib><creatorcontrib>Burchert, Wolfgang</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Hepatology (Baltimore, Md.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ahl, Björn</au><au>Weissenborn, Karin</au><au>van den Hoff, Jörg</au><au>Fischer‐Wasels, Daniela</au><au>Köstler, Herbert</au><au>Hecker, Hartmut</au><au>Burchert, Wolfgang</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Regional differences in cerebral blood flow and cerebral ammonia metabolism in patients with cirrhosis</atitle><jtitle>Hepatology (Baltimore, Md.)</jtitle><addtitle>Hepatology</addtitle><date>2004-07</date><risdate>2004</risdate><volume>40</volume><issue>1</issue><spage>73</spage><epage>79</epage><pages>73-79</pages><issn>0270-9139</issn><eissn>1527-3350</eissn><coden>HPTLD9</coden><abstract>Clinical and histopathological findings hint at regional differences in the brain's sensitivity to metabolic changes in cirrhosis. The aim of the present study was to examine regional differences in cerebral ammonia metabolism in patients with cirrhosis and grade 0‐to‐I hepatic encephalopathy (HE). 13N‐ammonia, 15O‐water positron emission tomography (PET) and magnetic resonance imaging (MRI) were performed. Quantitative values of cerebral blood flow (CBF) and the initial cerebral ammonia uptake rate (K1) were derived for several regions of interest from images of the desired parameters after interactive coregistration with the patients' MRI‐studies. CBF (mL/mL/min), K1 (mL/mL/min), and the ammonia extraction fraction (K1/CBF) showed marked regional variance with the highest levels in the thalamus, the lenticular nucleus, and the cerebellum. In conclusion, the regional differences in cerebral ammonia uptake correspond to the distribution of histopathological changes in the brain of patients with cirrhosis as well as clinical features of HE, characterized by signs of basal ganglia and cerebellar dysfunction with corresponding signs of functional impairment, especially of the frontal cortex and cingulate gyrus. (HEPATOLOGY 2004;40:73–79.)</abstract><cop>Hoboken</cop><pub>Wiley Subscription Services, Inc., A Wiley Company</pub><pmid>15239088</pmid><doi>10.1002/hep.20290</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Aged Ammonia - pharmacokinetics Biological and medical sciences Brain - metabolism Cerebellum - metabolism Cerebrovascular Circulation Corpus Striatum - metabolism Female Gastroenterology. Liver. Pancreas. Abdomen Hepatic Encephalopathy - diagnosis Hepatic Encephalopathy - etiology Hepatic Encephalopathy - metabolism Hepatic Encephalopathy - physiopathology Humans Liver Cirrhosis - complications Liver. Biliary tract. Portal circulation. Exocrine pancreas Magnetic Resonance Imaging Male Medical sciences Middle Aged Other diseases. Semiology Thalamus - metabolism Tissue Distribution Tomography, Emission-Computed |
| title | Regional differences in cerebral blood flow and cerebral ammonia metabolism in patients with cirrhosis |
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