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JYMS : Journal of Yeungnam Medical Science

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Hui Joong Lee 1 Article
Hepatic encephalopathy on magnetic resonance imaging and its uncertain differential diagnoses: a narrative review
Chun Geun Lim, Myong Hun Hahm, Hui Joong Lee
J Yeungnam Med Sci. 2023;40(2):136-145.   Published online January 10, 2023
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AbstractAbstract PDF
Hepatic encephalopathy (HE) is a severe neuropsychiatric abnormality in patients with either acute or chronic liver failure. Typical brain magnetic resonance imaging findings of HE are bilateral basal ganglia high signal intensities due to manganese deposition in chronic liver disease and hyperintensity in T2, fluid-attenuated inversion recovery, or diffusion-weighted imaging (DWI) with hemispheric white matter changes including the corticospinal tract. Low values on apparent diffusion coefficient mapping of the affected area on DWI, indicating cytotoxic edema, can be observed in acute HE. However, neuropsychological impairment in HE ranges from mild deficits in psychomotor abilities affecting quality of life to stupor or coma with higher grades of hepatic dysfunction. In particular, the long-lasting compensatory mechanisms for the altered metabolism in chronic liver disease make HE imaging results variable. Therefore, the clinical relevance of imaging findings is uncertain and differentiating HE from other metabolic diseases can be difficult. The recent introduction of concepts such as “acute-on-chronic liver failure (ACLF),” a new clinical entity, has led to a change in the clinical view of HE. Accordingly, there is a need to establish a corresponding concept in the field of neuroimaging diagnosis. Herein, we review HE from a historical and etiological perspective to increase understanding of brain imaging and help establish an imaging approach for advanced new concepts such as ACLF. The purpose of this manuscript is to provide an understanding of HE by reviewing neuroimaging findings based on pathological and clinical concepts of HE, thereby assisting in neuroimaging interpretation.


Citations to this article as recorded by  
  • Pattern Clustering of Symmetric Regional Cerebral Edema on Brain MRI in Patients with Hepatic Encephalopathy
    Chun Geun Lim, Hui Joong Lee
    Journal of the Korean Society of Radiology.2024; 85(2): 381.     CrossRef
  • Rule out all differential causes before attributing cerebral bleeding to 5-aminolevulinic acid
    Josef Finsterer, Sounira Mehri
    Child's Nervous System.2023; 39(4): 847.     CrossRef
  • Minimal hepatic encephalopathy: clinical, neurophysiological, neuroimaging markers
    P. I. Kuznetsova, A. A. Raskurazhev, S. N. Morozova, I. M. Lovchev, M. S. Novruzbekov, M. M. Tanashyan
    Russian neurological journal.2023; 28(5): 21.     CrossRef

JYMS : Journal of Yeungnam Medical Science