©Author(s) (or their employer(s)) 2026. No commercial re-use. See Permissions. Published by Baishideng Publishing Group Inc.
Role of cerebral blood flow changes in post-transjugular intrahepatic portosystemic shunts hepatic encephalopathy
Wan-Li Zhuang, Shang-Wen Xu, Jian Fang, Zhi-Qiang Zhang, Shi-An Zhang, Jie-Long Wang, Jiao-Long Zheng, Xiao-Yang Wang, Dong-Liang Li
Wan-Li Zhuang, Zhi-Qiang Zhang, Shi-An Zhang, Jie-Long Wang, Jiao-Long Zheng, Dong-Liang Li, Department of Hepatobiliary Disease, The 900th Hospital of PLA Joint Logistic Support Force, Fuzhou 350025, Fujian Province, China
Wan-Li Zhuang, Department of Gastroenterology, Jinjiang Municipal Hospital, Shanghai Sixth People’s Hospital Fujian, Jinjiang 362200, Fujian Province, China
Shang-Wen Xu, Xiao-Yang Wang, Department of Diagnostic Radiology, The 900th Hospital of PLA Joint Logistic Support Force, Fuzhou 350025, Fujian Province, China
Jian Fang, Department of Hepatobiliary Disease, The Third Affiliated People’s Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou 350025, Fujian Province, China
Co-corresponding authors: Xiao-Yang Wang and Dong-Liang Li.
Author contributions: Zhuang WL, Xu SW, and Fang J performed experiments and drafted the original paper; Zhuang WL, Xu SW, Fang J, Zhang ZQ, Zhang SA, Wang JL, and Zheng JL were responsible for the authenticity and completeness of data; Zhuang WL and Li DL designed the research study; Wang XY and Li DL were responsible for the ethics, overall research process as well as the writing and revision of the article, and they contributed equally to this manuscript and are co-corresponding authors. All authors approved the final version to be published.
Supported by Guiding Projects of Social Development of Fujian Province, No. 2021Y0062; and Natural Science Foundation of Fujian Province of China, No. 2024J011172.
Institutional review board statement: This study was approved by the Institutional Review Board of the 900th Hospital of the Joint Logistics Support Force (Approval No. 2023-001).
Clinical trial registration statement: This small prospective trial was registered with the local ethics institutional review board. It was not required to register an additional clinical trial registration.
Informed consent statement: Consent forms have been acquired from all participants.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: There is no additional data available.
Corresponding author: Dong-Liang Li, MD, PhD, Professor, Department of Hepatobiliary Disease, The 900
th Hospital of PLA Joint Logistic Support Force, No. 156 West Second Ring Road North, Fuzhou 350025, Fujian Province, China.
dongliangli93@163.com
Received: November 26, 2025
Revised: December 8, 2025
Accepted: January 13, 2026
Published online: February 28, 2026
Processing time: 92 Days and 0.3 Hours
BACKGROUND
Hepatic encephalopathy (HE) is the most common serious complication after transjugular intrahepatic portosystemic shunts (TIPS) surgery, the pathogenesis of which is not well understood.
AIM
To explore the mechanisms of HE after TIPS from a cerebral hemodynamic perspective and provide a theoretical basis for clinical treatment, three-dimensional arterial spin labeling and resting-state functional magnetic resonance imaging were applied in patients with portal hypertension post-TIPS to analyze dynamic changes in cerebral blood flow (CBF) and spontaneous brain activity, respectively.
METHODS
Patients who meet the inclusion criteria were selected as the case group, and 18 healthy volunteers were assigned as the control group. The differences in amplitude of low-frequency fluctuation (ALFF) and CBF between the case group and the control group before TIPS surgery and the differences in ALFF and CBF between the case group at each detection time point were compared and analyzed, and analyze the correlation between the changes in ALFF and CBF in the case group and the changes in clinical data.
RESULTS
Compared with the healthy control group, the CBF values of patients with cirrhosis and portal hypertension who were treated with TIPS were reduced in the area centered on the right orbitofrontal gyrus and the left superior temporal gyrus. ALFF scores decreased in the area centered on the left superior temporal gyrus, the left inferior frontal gyrus of the operculum and the right precuneus. Compared with preoperatively, CBF in the TIPS group increased in the area centered on the left fusiform gyrus at 1 month after surgery and the difference in CBF in this area was negatively correlated with the difference in the Child-Pugh liver function score. ALFF values increased in the area centered on the left superior temporal gyrus and the ALFF difference in this area was positively correlated with the portal vein pressure difference. There was no significant difference in CBF 3 months after TIPS in comparison to pre-TIPS. ALFF scores increased in the area centered on the left orbitofrontal gyrus and the left precuneus 3 months after TIPS surgery and the difference in ALFF in the left orbitofrontal gyrus was negatively correlated with the difference in the Digit Symbol Substitution Test score. Compared to 1 month after TIPS surgery, CBF values decreased in the area centered on the right fusiform gyrus and increased in the area centered on the left angular gyrus 3 months after TIPS surgery. The difference in CBF in the right fusiform gyrus was positively correlated with the difference in the Number Connection Test Part A score. ALFF values decreased in the area centered on the right insula and in the cerebellum.
CONCLUSION
TIPS surgery has a certain effect on spontaneous brain activity in patients with portal hypertension and cirrhosis for the increase in plasma ammonia as well as postoperative hemodynamic changes increasing CBF and may be factors causing HE. Resting-state functional magnetic resonance imaging is a sensitive diagnostic tool for HE, especially mild HE.
Core Tip: Using three-dimensional arterial spin labeling and resting-state functional magnetic resonance imaging, we dynamically evaluated cerebral blood flow and spontaneous brain activity in cirrhotic patients undergoing transjugular intrahepatic portosystemic shunts (TIPS). We demonstrated region-specific cerebral blood flow and amplitude of low-frequency fluctuation alterations after TIPS that correlated with changes in Child-Pugh score, portal pressure gradient and neuropsychological performance. These findings indicate that postoperative cerebral hemodynamic changes, together with hyperammonemia, may contribute to hepatic encephalopathy and that resting-state functional magnetic resonance imaging is a sensitive tool for detecting early or mild cognitive impairment after TIPS.
