AUTHOR=Huang Nao-Xin , Huang Hui-Wei , Dong Qiu-Yi , Wen Yu-Lin , Li Dan , Li Jian-Qi , Chen Hua-Jun 

TITLE=Metabolic alterations in the right anterior insula among patients with cirrhosis without overt hepatic encephalopathy: a magnetic resonance spectroscopy study

JOURNAL=Frontiers in Neurology

VOLUME=14

YEAR=2024

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1291478

DOI=10.3389/fneur.2023.1291478

ISSN=1664-2295

ABSTRACT=<sec><title>Purpose</title><p>We investigated metabolic alterations in the right anterior insula (rAI) in cirrhotic patients and determined its association with patients' cognitive dysfunction.</p></sec><sec><title>Methods</title><p>In this study, 31 healthy controls (HCs) and 32 cirrhotic patients without overt hepatic encephalopathy participated. Both blood ammonia level and Child-Pugh score were measured. The psychometric hepatic encephalopathy score (PHES) was used to evaluate cognitive function. <sup>1</sup>H-magnetic resonance spectroscopy (MRS) data located in the rAI were recorded on a commercially available 3T magnetic resonance imaging scanner. The ratios of metabolites were measured, including N-acetylaspartate (NAA)/total creatine (tCr), glutamate plus glutamine (Glx)/tCr, myo-inositol (mI)/tCr, and total choline (tCho)/tCr. We adopted the non-parametric Mann–Whitney <italic>U</italic>-test for intergroup comparison of metabolic ratios. To determine the association between metabolite concentration and clinical parameters, we performed Spearman correlation analyses.</p></sec><sec><title>Results</title><p>Patients with cirrhosis performed worse on PHES in comparison with HCs (<italic>P</italic> &lt; 0.001). Patients with cirrhosis had significantly decreased mI/tCr (0.87 ± 0.07 vs. 0.74 ± 0.19, <italic>P</italic> = 0.025) and increased Glx/tCr (1.79 ± 0.17 vs. 2.07 ± 0.29, <italic>P</italic> &lt; 0.001) in the rAI. We did not observe any significant between-group differences in tCho/tCr and NAA/tCr. The blood ammonia level was correlated with Glx/tCr (<italic>r</italic> = 0.405, <italic>P</italic> = 0.022) and mI/tCr (<italic>r</italic> = −0.398, <italic>P</italic> = 0.024) of the rAI. In addition, PHES was negatively correlated with Glx/tCr of the rAI (<italic>r</italic> = −0.379, <italic>P</italic> = 0.033).</p></sec><sec><title>Conclusion</title><p>Metabolic disturbance of the rAI, which is associated with ammonia intoxication, might account for the neural substrate of cirrhosis-related cognitive dysfunction to some extent.</p></sec>