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World J Gastroenterol. Sep 7, 2014; 20(33): 11815-11825
Published online Sep 7, 2014. doi: 10.3748/wjg.v20.i33.11815
Published online Sep 7, 2014. doi: 10.3748/wjg.v20.i33.11815
Non invasive blood flow measurement in cerebellum detects minimal hepatic encephalopathy earlier than psychometric tests
Vicente Felipo, Carla Giménez-Garzó, Omar Cauli, Laboratory of Neurobiology, Centro Investigación Príncipe Felipe, 46012 Valencia, Spain
Amparo Urios, Maria-Jesús Andrés-Costa, Carmina Montoliu, Fundación Investigación Hospital Clínico de Valencia. Instituto de Investigación Sanitaria, INCLIVA, 46010 Valencia, Spain
Olga González, Remedios Giner-Durán, Servicio Digestivo, Hospital Arnau de Vilanova, 46015 Valencia, Spain
Miguel A Serra, Grupo Hepatología, Servicio Aparato Digestivo, Hospital Clínico de Valencia, 46010 Valencia, Spain
Javier Sánchez-González, Philips Healthcare, Iberia, 28050 Madrid, Spain
Roberto Aliaga, Vicente Belloch, ERESA, Unidad RM, 46015 Valencia, Spain
Roberto Aliaga, Vicente Belloch, Departamento de Patología, Facultad de Medicina, Universidad de Valencia, 46010 Valencia, Spain
Author contributions: Urios A, Giménez-Garzó C, Cauli O and Andrés-Costa MJ performed psychometric tests, biochemical determinations, and analysis of blood flow in brain areas; González O, Serra MA, and Giner-Durán R selected of patients and provided the analytical data; Sánchez-González J designed the homemade software for blood flow analysis; Aliaga R and Belloch V contributed to magnetic resonance acquisition, interpretation of data, revising the manuscript; Felipo V and Montoliu C designed the study, obtained funding, performed analysis and interpretation of data and wrote the paper; all authors approved the final version of the article.
Supported by Ministerio de Ciencia e Innovación, Nos. FIS PS09/00806; FIS PI12/00884 to Montoliu C; SAF2011-23051, CSD2008-00005 to Felipo V; Consellería de Educación Generalitat Valenciana, Nos. PROMETEO-2009-027, ACOMP/2012/066 to Felipo V, No. ACOMP/2012/056 to Montoliu C; Sanitat, No. AP-004/11 to Felipo V, AP-087/11 to Montoliu C; Fundación ERESA to Montoliu C
Correspondence to: Carmina Montoliu, PhD, Fundación Investigación Hospital Clínico de Valencia. Instituto de Investigación Sanitaria, INCLIVA, , Avda Blasco Ibañez, 17, 46010 Valencia, Spain. cmontoliu@incliva.es
Telephone: +34-96-3864381 Fax: +34-96-3289701
Received: November 7, 2013
Revised: February 23, 2014
Accepted: May 19, 2014
Published online: September 7, 2014
Processing time: 303 Days and 18.1 Hours
Revised: February 23, 2014
Accepted: May 19, 2014
Published online: September 7, 2014
Processing time: 303 Days and 18.1 Hours
Core Tip
Core tip: Patients with minimal hepatic encephalopathy (MHE) show neurological impairment in specific tasks to which selective regional alterations in blood flow (BF) could contribute. Arterial spin labeling (ASL), a non-invasive magnetic resonance technique, quantitatively measures cerebral perfusion. We analyzed BF by ASL in different brain areas of controls and cirrhotic patients without and with MHE. We found that BF is more affected in cerebellum than in other areas of cirrhotic patients and that BF determination in cerebellum using ASL may detect MHE earlier than the Psychometric Hepatic Encephalopathy Score battery. Altered nitric oxide-cGMP pathway seems to be associated to altered BF in cerebellum.