Study On White Matter Changes Of Minimum Hepatic Encephalopathy Based On MRI Diffusion Imaging

Objective: Magnetic resonance diffusion kurtosis imaging(DKI)and diffusion tensor imaging(DTI)are used to detect white matter abnormalities in mild hepatic encephalopathy(MHE)patients,and to explore the clinical diagnostic value of DKI and DTI in MHE patients.To compare the differences between DKI and DTI techniques in detecting white matter abnormalities in MHE.Materials and Methods: Patients with hepatitis B cirrhosis diagnosed in the Department of Hepatology,Taizhou People’s Hospital were selected as the research objects,and the research objects were tested by digital connection test-A(NCT-A)and digital symbol test(DST).And 21 patients with MHE were screened out.At the same time,17 healthy volunteers were recruited as the healthy control group.All participants were scanned by conventional magnetic resonance imaging(MRI),DKI and DTI.The indicators for evaluating white matter included: FA,AD,RD,MD,MK,AK,RK calculated from DKI data;FA,AD,RD and MD were calculated from DTI data,and these indice were analyzed by tract-based spatial statistics(TBSS)method,and the differences between groups were compared.Results: 1.The kurtosis index of DKI was significantly different between MHE patients and normal controls before(P < 0.05);compared with the normal control,the kurtosis index of DKI in MHE patients decreased significantly.The percentage of leukotropins significantly reduced by DKI_MK,DKI_AK and DKI_RK accounted for about 16.67%,16.88% and 15% of the total white matter skeleton voxels respectively.2.The diffusion index of DKI was significantly different between MHE patients and normal controls(P < 0.05);compared with normal controls,the values of DKI_FA in MHE patients decreased significantly,while the values of DKI_AD,DKI_RD and DKI_MD increased significantly.The percentage of leukotropins significantly reduced by DKI_FA accounted for about 19% of the total white matter skeleton voxels,while the percentage of leukotropins significantly increased by DKI_AD,DKI_RD,and DKI_MD accounted for 18.8%,16.5%,and 17.4% of the total white matter skeleton voxels,respectively.3.The diffusion index of DTI was significantly different between MHE patients and normal controls(P < 0.05);similar to the change of DKI diffusion index,compared with the normal control,the DTI_FA value of MHE patients decreased significantly,and the decreased percentage of leukoplast voxels accounted for about 17% of the total white matter skeleton voxels.DTI_MD and DTI_RD increased significantly,and the increased percentage of leukoplast voxels accounted for about 15.99% and 15.41% of the total white matter skeleton voxels,respectively.DTI_AD did not have any difference between the two groups.4.There was a good correlation between DST score and all indexes of DKI and DTI.It was positively correlated with the DKI_FA value of the right anterior corona radiata,the DKI_MK value of the right temporal lobe white matter,the DKI_AK value of the fornix,the DKI_RK value of the left temporal lobe white matter,and the DTI_FA value of the left anterior corona radiata in the main difference brain regions.It was negatively correlated with the DKI_AD value of the left external capsule,the DKI_RD value of the left anterior corona radiata,the DTI_RD value of the left posterior thalamic radiation,and the DTI_MD value of the genu of the corpus callosum;there was no correlation between NCT-A completion time and all index values;the Child-Pugh score was positively correlated with the values of DKI_RD,DKI_MD and DTI_RD in the main difference brain regions,and negatively correlated with the values of DKI_MK,DKI_AK and DTI_FA.Conclusions:1.The index values of DTI and DKI can detect the abnormality of white matter in MHE patients,and DTI and DKI may become an important imaging technique for early diagnosis of MHE;2.Compared with DTI,DKI detects a wider range of MHE white matter abnormalities.DKI is more sensitive than DTI in the white matter fiber intersection area,and DKI may have more advantages than DTI in detecting MHE white matter changes;3.On the basis of neuropsychological test,DTI and DKI provide an objective and repeatable method for the diagnosis of mild hepatic encephalopathy by detecting the changes of white matter.