Brain synthetic magnetic resonance imaging and quantitative susceptibility mapping in patients with hepatitis B virus-related decompensated cirrhosis.

Background: The traditional diagnostic methods for early hepatic encephalopathy (HE) detection involve certain limitations, including subjectivity and low sensitivity. This study aimed to integrate synthetic magnetic resonance imaging (SyMRI) and quantitative susceptibility mapping (QSM) techniques to examine the changes in quantitative parameter values of patients with hepatitis B virus-related (HBV-related) decompensated cirrhosis, with the goal of providing imaging-based evidence for early neurological symptoms and disease monitoring in patients with cirrhosis.

Methods: Data from 41 patients with HBV-related decompensated cirrhosis and 40 healthy controls were prospectively collected. T1 values, T2 values, proton density (PD) values, and magnetic susceptibility values of the bilateral frontal white matter, parietal white matter, occipital white matter, caudate nuclei, putamen, globus pallidus, thalamus, substantia nigra, red nuclei, and dentate nuclei were measured. Analysis of covariance (ANCOVA) was used to compare these values between the two groups. P values obtained were then corrected via the false-discovery rate (FDR) method. Correlation analysis was used to determine the correlation between the brain quantitative parameter values of patients and their clinical indicators.

Results: In the SyMRI study, patients with cirrhosis had significantly lower T1 values in the right frontal white matter (RFWM) (P=0.030), left frontal white matter (LFWM) (P=0.043), right parietal white matter (RPWM) (P=0.038), left parietal white matter (LPWM) (P=0.043), right occipital white matter (ROWM) (P=0.016), right caudate nuclei (P<0.001), left caudate nuclei (P=0.003), right putamen (RPUT) (P<0.001), left putamen (P<0.001), right globus pallidus (RGP) (P=0.007), right thalamus (RTHA) (P=0.044), right substantia nigra (RSN) (P=0.019), right dentate nuclei (P=0.033), and left dentate nuclei (P=0.016). Additionally, these patients had significantly lower T2 values in the RPUT (P=0.026), left putamen (P=0.043), RTHA (P=0.026), and left thalamus (LTHA) (P=0.016), along with significantly lower PD values in the RPWM (P=0.045), right caudate nuclei (P<0.001), left caudate nuclei (P<0.001), RPUT (P<0.001), left putamen (P<0.001), RTHA (P=0.016), right red nucleus (RRN) (P=0.016), and left red nucleus (LRN) (P=0.016). Moreover, the platelet count of patients was positively correlated with the T1 and PD values in the caudate nuclei (T1 right: r=0.451, P=0.030; T1 left: r=0.397, P=0.042; PD right: r=0.443, P=0.030; PD left: r=0.476 P=0.030) and putamen (T1 right: r=0.453, P=0.030; T1 left: r=0.400, P=0.042; PD right: r=0.463, P=0.030; PD left: r=0.510, P=0.026). In the QSM study, patients tended to exhibit an increase in magnetic susceptibility value in the ROWM and LTHA.

Conclusions: The measurement of T1 values, T2 values, PD values, and magnetic susceptibility values in deep gray-matter nuclei and white matter could contribute to the early warning of neurological symptoms and monitoring of disease progression in patients with HBV-related cirrhosis. Among these parameters, T1 and PD values may exhibit higher sensitivity as compared to magnetic susceptibility values.