Paul E. Sijens, Presenter: Nothing to Disclose

Henkjan J Verkade, Abstract Co-Author: Nothing to Disclose

Heyder Alkefaji, Abstract Co-Author: Nothing to Disclose

Roelineke J. Lunsing, Abstract Co-Author: Nothing to Disclose

Francjan J. van Spronsen, Abstract Co-Author: Nothing to Disclose

Matthys Oudkerk MD, PhD, Abstract Co-Author: Nothing to Disclose

Acute liver failure (ALF) related encephalopathy was previously characterized by MR spectroscopy of single voxels containing both gray and white matter brain tissue. Quantitative multivoxel MR spectroscopy was used here to compare gray and white matter brain tissue concentrations of glutamate/glutamine (Glx) and lactate in ALF and associate the results with other liver function parameters.

Five pediatric patients with ALF related encephalopathy and 5 controls, children who had undergone successful liver transplantation, were examined at 1.5T by 2D-chemical shift imaging (CSI) point resolved spectroscopy measurement of a transverse supraventricular plane containing both white and gray brain tissue, with a repetition time of 1500 ms and an echo time of 135 ms

ALF patients had higher Glx and lactate concentrations in brain white matter than controls (Glx +125%: P<0.01; lactate +33%, P<0.05) and higher Glx in gray matter (Glx +125%: P<0.01). Within the group of ALF patients positive correlations were found between gray or white matter lactate concentration and serum ammonia (P < 0.05), and negative correlations between grey or white matter Glx and venous pH (P < 0.001).

This is the first study presenting evidence of high Glx levels in both white and grey matter brain tissue in ALF related encephalopathy. The elevations in CNS Glx and lactate concentrations appear to relate to hepatic detoxification (ammonia, venous pH), rather than to liver parenchymal integrity (aspartate aminotransferase, alanine aminotransferase) or biliary cholestasis (bilirubin, γ-glutamyl transpeptidase, alkaline phosphatase).

The correlation of brain metabolites with abnormal biochemistry rather than encephalopathy opens an opportunity for further exploration by the study of subjects with ALF but without encephalopathy.

Sijens, P, Verkade, H, Alkefaji, H, Lunsing, R, van Spronsen, F, Oudkerk, M, Brain Glutamate and Lactate Level Increases in Acute Liver Failure as Demonstrated by Chemical Shift Imaging.  Radiological Society of North America 2008 Scientific Assembly and Annual Meeting, February 18 - February 20, 2008 ,Chicago IL. http://archive.rsna.org/2008/6012375.html