| Objective To investigate the spontaneous brain activities in cirrhosis patients in preand post-operation of transjugular intrahepatic portosystemic shunt(TIPS)using resting-state functional MRI(rs-f MRI).Methods The data of 114 cirrhotic patients in five groups which included 18 cases in pre-operation of TIPS,29 cases in the 1-month follow-up,21 cases in the 3-month follow-up,25 cases in the 6-month follow-up and 21 cases in the 1-year follow-up were selected.Meanwhile,30 age-and sex-matched healthy volunteers were selected as control group.All subjects performed rs-f MRI scans.All subjects excepted control group performed blood biochemical examination in laboratory.The rs-f MRI data processed with DPARSF and SPM12 softwares,whole-brain fractional amplitude of low frequency fluctuation(f ALFF)values and functional connectivity(FC)values of brain default mode network(DMN)were acquired,and one-way analysis of variance,multiple comparison analysis and correlation analysis were performed.Results 1.There were brain regions with significant changes on f ALFF in patients groups,including bilateral middle temporal gyrus,left inferior temporal gyrus,right superior temporal gyrus,right orbital middle frontal gyrus,right orbital inferior frontal gyrus,right insula,right anterior cingulate gyrus,left calcarine,left middle occipital gyrus,bilateral cuneus,bilateral cerebelum(P<0.005).2.Compared with control group,patients in pre-operation of TIPS showed that f ALFF of brain function areas increased in right orbital middle frontal gyrus,,left superior occipital gyrus,left cerebelum,and decreased in left cuneus,left calcarine,right superior occipital gyrus,right inferior occipital gyrus,right paracentral lobule,bilateral cerebelum(P<0.005).3.Multiple comparison analysis on f ALFF in patients groups show that,compared with patients in pre-operation of TIPS,patients in the 1-month follow-up showed that brain function areas increased in left superior occipital gyrus,left middle occipital gyrus,left superior parietal gyrus,left calcarine,right cuneus,and decreased in left middle temporal gyrus,left anterior cingulate gyrus,left middle cingulate gyrus,left posterior cingulate gyrus,right cuneus,right calcarine,.patients in the 3-month follow-up showed that brain function areas increased in left middle occipital gyrus,left fusiform gyrus,left calcarine,right superior occipital gyrus,right inferior occipital gyrus,right lingual,right cerebelum,and decreased in left middle cingulate gyrus,right anterior cingulate gyrus,right lingual,right orbital middle frontal gyrus,right cuneus.patients in the6-month follow-up showed that brain function areas increased in left cuneus,right cerebelum,and decreased in right precuneus,right cuneus,right superior parietal gyrus,patients in the 1-year follow-up showed that brain function areas increased inright cerebelum,and decreased in right middle temporal gyrus(P<0.001).compared with patients in the 1-month follow-up,patients in the 3-month follow-up showed that brain function areas increased in left olfactory cortex,left inferior temporal gyrus,left fusiform gyrus,left orbital middle frontal gyrus,left putamen,left cerebelum,and decreased in left lingual gyrus;patients in the 6-month follow-up showed that brain function areas increased in left middle temportal gyrus,right supramarginal gyrus,right temporal pole,right central operculum,and decreased in left top edge of angular gyrus,left postcentral gyrus,patients in the 1-year follow-up showed that brain function areas increased in right hippocampus,right middle cingulate gyrus,and decreased in right middle temportal gyrus(P<0.001).Compared with patients in the 3-month follow-up,patients in the 6-month follow-up showed that brain function areas increased in left superior temporal gyrus,left middle temporal gyrus,right temporal pole,right island of inferior frontal gyrus,and decreased in left cerebelum,left orbital inferior frontal gyrus,patients in the 1-year follow-up showed that there were no obvious increase and decrease brain function areas(P < 0.001).Compared with patients in the 6-month follow-up,patients in the 1-year follow-up showed that there were no obvious increase brain function areas,but brain function areas decreased in bilateral middle temportal gyrus(P<0.001).4.Correlation analysis on f ALFF in patients groups show that,brain regions were positively related to blood ammonia in middle cingulate gyrus,posterior cingulate gyrus,right central operculum,bilateral cerebelum,whileas brain regions were negatively related to blood ammonia in bilateral medial prefrontal lobe,bilateral precentral gyrus,bilateral postcentral gyrus,left superior parietal gyrus,left angular gyrus(P<0.005).5.Correlation analysis on f ALFF in patients groups show that,brain regions were positively related to indirect bilirubin in right frontal lobe,right precentral gyrus,right postcentral gyrus,right putamen,right cerebelum,left dorsolateral superior frontal gyrus,left supplementary motor area,whileas brain regions were negatively related to indirect bilirubin in bilateral orbital inferior frontal gyrus,bilateral superior temporal gyrus,bilateral heschl gyrus,bilateral precentral gyrus,left insula,left superior parietal gyrus(P<0.005).6.There were brain regions with significant changes on FC of posterior cingulate gyrus in patients groups,including bilateral cerebelum,left thalamus,left calcarine,right precentral gyrus,right precuneus,vermis(P<0.005).7.Compared with control group,patients in pre-operation of TIPS showed that FC of posterior cingulate gyrus increased in right orbital middle frontal gyrus,left pars triangularis gyri frontalis inferioris,left middle frontal gyrus,left inferior temporal gyrus,and decreased in bilateral cerebelum,vermis(P<0.005).8.Multiple comparison analysis on FC of posterior cingulate gyrus in patients groups show that,compared with patients in pre-operation of TIPS,patients in the 1-month follow-up showed that brain function areas increased in right cerebelum,and decreased in left calcarine,right precuneus,patients in the 3-month follow-up showed that brain function areas increased in bilateral cerebelum,bilateral fusiform gyrus,vermis,and decreased in left middle frontal gyrus,patients in the 6-month follow-up showed that brain function areas increased in left superior temporal gyrus,left thalamus,right cerebelum,and decreased in left middle temporal gyrus,left middle occipital gyrus,right orbital middle frontal gyrus,patients in the 1-year follow-up showed that brain function areas increased in bilateral cerebelum,but there were no obvious decrease brain function areas(P < 0.001).Compared with patients in the 1-month follow-up,patients in the3-month follow-up showed that brain function areas increased in bilateral inferior temporal gyrus,left middle temporal gyrus,bilateral cerebelum,bilateral fusiform gyrus,but there were no obvious decrease brain function areas,patients in the 6-month follow-up showed that brain function areas increased in left inferior temporal gyrus,but there were no obvious decrease brain function areas.patients in the 1-year follow-up showed that brain function areas increased in bilateral cerebelum,right inferior temporal gyrus,right thalamus,right putamen,right hippocampus,and decreased in left superior parietal gyrus(P<0.001).Compared with patients in the 3-month follow-up,patients in the 6-month follow-up showed that there were no obvious increase and decrease brain function areas.patients in the 1-year follow-up showed that there were no obvious increase brain function areas,but brain function areas decreased in left middle temportal gyrus,right precentral gyrus(P < 0.001).Compared with patients in the 6-month follow-up,patients in the 1-year follow-up showed that there were no obvious increase brain function areas,but brain function areas decreased in left middle temportal gyrus(P<0.001). 9.Correlation analysis on FC of posterior cingulate gyrus in patients groups show that,brain regions were positively related to blood ammonia in right medial prefrontal lobe,left cuneus,right precuneus,whileas brain regions were negatively related to blood ammonia in middle cingulate gyrus(P<0.005).10.Correlation analysis on FC of posterior cingulate gyrus in patients groups show that,brain regions were positively related to indirect bilirubin in right frontal lobe,left middle frontal gyrus,bilateral superior temporal gyrus,right temporal gyrus,bilateral angular gyrus,bilateral precentral gyrus,bilateral postcentral gyrus,bilateral supplementary motor area,right middle occipital gyrus,right superior parietal gyrus,left supramarginal,left top edge of angular gyrus,left central operculum,left cerebelum,whileas brain regions were negatively related to indirect bilirubin in left hippocampus,left superior parietal gyrus(P<0.005).Conclusion The resting state brain function changes in cirrhosis patients with TIPS operation,and the changes along with course of disease,meanwhile part of the brain regions function can be gradually improved.The brain function had increased or decreased in cirrhosis patients after TIPS operation,which may be related to the damage and compensatory some brain regions.The changes of brain regions function had significant correlation with blood ammonia or indirect bilirubin levels. |
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