肝性腦病磁共振成像研究進展LS課件

1、肝性腦病磁共振成像研究進展LS肝性腦病磁共振成像研究進展LS肝性腦病磁共振成像研究進展LSOutlineConceptClassificationClinical FeaturesPathophysiology MR charactersConclusions”通過閱讀科技書籍，我們能豐富知識，培養(yǎng)邏輯思維能力；肝性腦病磁共振成像研究進展LS肝性腦病磁共振成像研究進展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肝性腦病是由各種嚴重肝臟疾病引起的以代謝紊亂為基礎的中樞神經系統功能失調綜合征。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,輕微肝性腦病)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（高信號） basal ganglia: globus pallidus, substant

7、ia nigra reticulate, and striatum limbic system (hippocampus, temporal lobe, cingulate gyrus, and fornix) white matterBrain atrophy（腦萎縮）T1-Weighted/VolumetricHyperint肝性腦病磁共振成像研究進展LS課件TIPS(經頸靜脈門體分流術)12TIPS(經頸靜脈門體分流術)12Brain atrophyBrain atrophyVolumetric MRIZhang LJ, et al. PLoS One, 2012Caudate（尾狀核）

8、Thalamus （丘腦）Volumetric MRIZhang LJ, et al.Volumetric MRITao R, et al. EJR, 2013Thalamus volume increase(丘腦體積增加)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肝性腦病磁共振成像研究進展LS課件DWI

9、and DTIBrain edemaDWI and DTIBrain edema肝性腦病磁共振成像研究進展LS課件DTIDMNQi R, et al.PLoS One , 2012 fMRIDTIDMNQi R, et al.fMRITBSS and VBMTBSSVBMammoniaQi R, Zhang LJ*, et al. Eur Radiol, 2013FA(FA)平均擴散率(MD)MHEBrain atrophyBain edemaGray matter decreaseWhiter matter FA decrease and MD increase丘腦尾狀核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(背側注意網絡)DMN (腦默認網絡)VN (視覺網絡)AN (聽覺網絡)SMN(感覺運動網絡)SRN(自我參照網絡)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肝性腦病磁共振成像研究進展LS課件MRS (1H-MRS, 31P-MRS, 13C-MRS )1H-MRS31P-MRS13C-MRSGlx increasemIns decreasewhite matter MRS (1H-MRS, 31P-MRS, 13C-MRS 肝性腦病磁共振成像研究進展LS課件SWI Susceptibility increase left frontal white matter bilateral caudate head right substantia nigraOtherSWI OtherOtherT