Zhongguo quanke yixue (Aug 2023)
Evaluation of Cognitive Impairment in Patients with Minimal Hepatic Encephalopathy Based on Degree Centrality of Resting-state Blood Oxygenation Level-dependent Functional Magnetic Resonance Imaging
Abstract
Background Minimal hepatic encephalopathy has atypical clinical symptoms but mild neuropsychiatric deficits, which are easily neglected by patients and their family members as a specific type of hepatic encephalopathy. The degree centrality (DC) analysis method based on resting-state blood oxygenation level-dependent functional magnetic resonance imaging (BOLD-fMRI) is a data analysis method derived from graph-theoretic approach reflecting whole-brain network connectivity, which can provide a more complete, faster and better representation of brain function. Objective To explore the effects of abnormal changes in the brain functional network connectivity properties and functional brain regions on cognitive function in patients with minimal hepatic encephalopathy and their neuroimaging mechanisms. Methods A total of 65 patients with hepatitis B cirrhosis hospitalized in the department of infectious diseases in General Hospital of Ningxia Medical University from October 2020 to February 2022 and 40 healthy volunteers recruited during the same period were selected as the study subjects. Gender, age, education level, number connection test A (NCT-A) score, digit symbol test (DST) score and Montreal cognitive assessment (MoCA) score of the study subjects were collected. Finally, patients with hepatitis B cirrhosis were divided into cirrhosis group (n=30) and MHE group (n=28) according to NCT-A and DST scores, and the recruited healthy volunteers were considered as the healthy control group (n=34) . The DC values of brain regions in each group were calculate, the differences in DC values of brain image between MHE group and cirrhosis group, cirrhosis group and healthy control group, MHE group and healthy control group were compared, respectively. The correlations between the DC values of brain regions with the scores of NCT-A, DST and MoCA in MHE patients was analyzed by using person correlation analysis, the distribution of brain regions with DC values correlated with the scores of above scales and the corresponding scatter plots were drawn. Results The NCT-A score in the healthy control and cirrhotic group was lower than MHE group, DST score and MoCA score in the healthy control and cirrhotic group were higher than MHE group (P<0.05) . Compared with healthy control group, the MHE group had increased DC values in right middle frontal gyrus, left middle temporal gyrus, right inferior parietal lobule and decreased DC values in left angular gyrus, right middle occipital gyrus, right precentral gyrus (voxel cluster>18, P<0.05) . Compared with healthy control group, cirrhotic group had increased DC values in the bilateral middle temporal gyrus and decreased DC values in the left angular gyrus (voxel cluster>18, P<0.05) ; compared with cirrhotic group, MHE group had decreased values in the right middle temporal gyrus and left precuneus (voxel cluster>18, P<0.05) . The results of correlation analysis showed that in the MHE group, the DST score was correlated with DC values in the left superior temporal gyrus (r=0.639, P<0.001) , and the NCT-A score was negatively correlated with the DC values in the right inferior temporal gyrus (r=-0.722, P<0.001) ; MoCA scale score was positively correlated with DC values in the right inferior frontal gyrus and left inferior frontal gyrus (r=0.437, P=0.020; r=0.549, P=0.002) and negatively correlated with DC values in the left inferior temporal gyrus (r=-0.591, P=0.001) . Conclusion The abnormal functional connectivity of several brain regions and the correlation of DC values in some brain regions with NCT-A, DST and MoCA scale scores in MHE patients suggest that DC value may be a potential neuroimaging marker to quantify the severity of cognitive changes in MHE patients.
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