肝性脑病磁共振成像研究进展LS课件

1、肝性脑病磁共振成像研究进展LS肝性脑病磁共振成像研究进展LS肝性脑病磁共振成像研究进展LSOutlineConceptClassificationClinical FeaturesPathophysiology MR charactersConclusions”通过阅读科技书籍，我们能丰富知识，培养逻辑思维能力；肝性脑病磁共振成像研究进展LS肝性脑病磁共振成像研究进展LSOutlineConceptClassificationClinical FeaturesPathophysiology MR charactersConclusionsOutlineConceptConceptHepatic

2、 encephalopathy is a term encompassing a wide spectrum of neuropsychiatric abnormalities related to liver dysfunction that can be partially or completely reversible after function normalizes肝性脑病是由各种严重肝脏疾病引起的以代谢紊乱为基础的中枢神经系统功能失调综合征。ConceptHepatic encephalopathy ClassificationMechanism causeType A, ass

3、ociated with acute liver failure (ALF)Type B, associated with portal-systemic bypass without intrinsic hepatocellular disease Type C, associated with cirrhosis and portal hyper- tension or portal-systemic shunts the most common typeClassificationMechanism causeLength or characteristics Overt HE(OHE)

4、 Episodic Persistent Minimal HE(MHE,轻微肝性脑病)Length or characteristicsClinical Features OHE Motor alterations rigidity, speech disorders, tremor, hyperreflexia, hyporeflexia,babinskisigns Mental abnormalities range from mild changes to comaMHE impaired short- and long-term memory depression and anxiet

5、yClinical Features OHEPathophysiologyAbnormal accumulation of certain substances in the blood: ammonia, manganeseNeurotransmission abnormalityInjury to the astrocytesMicroglia activation(neuroinflammation) PathophysiologyAbnormal accumuDiagnosisClinical feature Imaging CT MRI PET/SPECTCFF(Critical F

6、licker Frequency)EEGNeuropsychological testsDiagnosisClinical feature MRI in HE T1-Weighted/VolumetricT2-Weighted/T2-FlairDWI/DTIMTIFMRIPerfusionMRS (1H-MRS,31P-MRS,13C-MRS)Other(SWI, T2*)MRI in HE T1-Weighted/VolumetrT1-Weighted/VolumetricHyperintensity（高信号） basal ganglia: globus pallidus, substant

7、ia nigra reticulate, and striatum limbic system (hippocampus, temporal lobe, cingulate gyrus, and fornix) white matterBrain atrophy（脑萎缩）T1-Weighted/VolumetricHyperint肝性脑病磁共振成像研究进展LS课件TIPS(经颈静脉门体分流术)12TIPS(经颈静脉门体分流术)12Brain atrophyBrain atrophyVolumetric MRIZhang LJ, et al. PLoS One, 2012Caudate（尾状核）

8、Thalamus （丘脑）Volumetric MRIZhang LJ, et al.Volumetric MRITao R, et al. EJR, 2013Thalamus volume increase(丘脑体积增加)Volumetric MRITao R, et al. EJT2-Weighted/T2-FLAIRDiffuse high signal intensity white matter lesions in or around the corticospinal tractT2-Weighted/T2-FLAIRDiffuse hi肝性脑病磁共振成像研究进展LS课件DWI

9、and DTIBrain edemaDWI and DTIBrain edema肝性脑病磁共振成像研究进展LS课件DTIDMNQi R, et al.PLoS One , 2012 fMRIDTIDMNQi R, et al.fMRITBSS and VBMTBSSVBMammoniaQi R, Zhang LJ*, et al. Eur Radiol, 2013FA(FA)平均扩散率(MD)MHEBrain atrophyBain edemaGray matter decreaseWhiter matter FA decrease and MD increase丘脑尾状核TBSS and V

10、BMTBSSVBMammoniaQi RMagnetization Transfer Imaging MTR decreaseBasal gangliaPosterior white matterMiese FR, et al. WJR, 2009Magnetization Transfer ImagingFunctional MRI (fMRI) Zhang LJ, et al. HBM,2011Default-mode network (DMN)LPCC, precuneus, RAG, MFC left parahippocampusHCHEFunctional MRI (fMRI) Z

11、hang LJAmplitude of low frequency fluctuation analysis（ALFF）Qi R, et al. Radiology, 2012Amplitude of low frequency fluQi R, Zhang LJ*, et al. PloS One, DAN(背侧注意网络)DMN (脑默认网络)VN (视觉网络)AN (听觉网络)SMN(感觉运动网络)SRN(自我参照网络)25Resting-State Networks(ICA)Qi R, Zhang LJ*, et al. PloS OZhang LJ*, et al. Radiology

12、, 2012basal gangliathalamocorticalcircuitWidespread cortical and subcortical network connectivity changes Functional network26Zhang LJ*, et al. Radiology, 2Perfusion Imaging PWI(DSC)ASLZheng G, et al. EJR,2012CBF diffusely increase Pre-TIPS Post-TIPSPerfusion Imaging PWI(DSC)Zhen肝性脑病磁共振成像研究进展LS课件MRS (1H-MRS, 31P-MRS, 13C-MRS )1H-MRS31P-MRS13C-MRSGlx increasemIns decreasewhite matter MRS (1H-MRS, 31P-MRS, 13C-MRS 肝性脑病磁共振成像研究进展LS课件SWI Susceptibility increase left frontal white matter bilateral caudate head right substantia nigraOtherSWI OtherOtherT