Role of cerebral blood flow changes in post-transjugular intrahepatic portosystemic shunts hepatic encephalopathy

doi:10.4329/wjr.v18.i2.116973

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Feb 28, 2026 (publication date) through Feb 28, 2026

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World Journal of Radiology

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1949-8470

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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©Author(s) (or their employer(s)) 2026. No commercial re-use. See Permissions. Published by Baishideng Publishing Group Inc.

World J Radiol. Feb 28, 2026; 18(2): 116973
Published online Feb 28, 2026. doi: 10.4329/wjr.v18.i2.116973

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 900^th 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 900^th 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 900^th 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

Core Tip

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.