Dynamic evolution of microstructure in thalamic subregions of patients with cirrhosis: A study based on diffusion kurtosis imaging.

Objectives: To investigate the cross-sectional and longitudinal dynamics of the thalamic subregion microstructure in patients with liver cirrhosis by diffusion kurtosis imaging (DKI) and explore its relationship with cognitive function.

Materials And Methods: DKI was performed on 50 with hepatic encephalopathy (HE), 46 without hepatic encephalopathy (non-HE), and 41 healthy controls (HC). 61 of these cirrhotic patients underwent liver transplantation (LT) surgery and DKI again one month later to compare the diffusion parameters before and after surgery. Correlations between neuroimaging changes and neuropsychological clinical features were analyzed.

Results: We noticed increased axial diffusion (AD), radial diffusion (RD) and mean diffusion (MD), and decreased axial kurtosis (AK), radial kurtosis (RK), mean kurtosis (MK), and fractional anisotropy (FA) in most thalamic subregions of patients with liver cirrhosis, indicating low-grade cerebral edema and microstructural damage. We observed a compensatory increase in MK in the PPtha_r subregion in the patient group. The reduction in the MK from the non-HE to HE group may relate to the promotion of astrocyte apoptosis by HE attack. One month after LT, most thalamic subregional parameters tended to deteriorate, and lPFtha was the first subregion to exhibit increased DKI parameters.

Conclusion: DKI can better detect the dynamic changes in the microstructure of the thalamus after HE and LT surgery. The decrease in DKI parameter in the HE group compared to the non-HE group may relate to neuronal apoptosis. lPFtha is the thalamic subregion where structural recovery first occurs 1-month after LT.