Halphen Jr J, Dayal YS, Laurie C, Ahmadzade M, Wynne D, Ghasemi-Rad M. Letter to the Editor: Hemodynamic role in hepatic encephalopathy pathogenesis following transjugular intrahepatic portosystemic shunt placement. World J Radiol 2026; 18(6): 120177 [DOI: 10.4329/wjr.120177]
Corresponding Author of This Article
Mohammad Ghasemi-Rad, MD, Department of Radiology, Section of Vascular and Interventional Radiology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, United States. mohammad.ghasemirad@bcm.edu
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Radiology, Nuclear Medicine & Medical Imaging
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letter
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Halphen Jr J, Dayal YS, Laurie C, Ahmadzade M, Wynne D, Ghasemi-Rad M. Letter to the Editor: Hemodynamic role in hepatic encephalopathy pathogenesis following transjugular intrahepatic portosystemic shunt placement. World J Radiol 2026; 18(6): 120177 [DOI: 10.4329/wjr.120177]
World J Radiol. Jun 28, 2026; 18(6): 120177 Published online Jun 28, 2026. doi: 10.4329/wjr.120177
Letter to the Editor: Hemodynamic role in hepatic encephalopathy pathogenesis following transjugular intrahepatic portosystemic shunt placement
John Halphen Jr, Yash S Dayal, Cameron Laurie, Mohadese Ahmadzade, David Wynne, Mohammad Ghasemi-Rad
John Halphen Jr, Yash S Dayal, Cameron Laurie, Mohadese Ahmadzade, David Wynne, Mohammad Ghasemi-Rad, Department of Radiology, Section of Vascular and Interventional Radiology, Baylor College of Medicine, Houston, TX 77030, United States
Author contributions: Halphen Jr J, Dayal YS, Laurie C, and Ghasemi-Rad M conceptualized the work; Halphen Jr J and Ghasemi-Rad M designed the article; Ahmadzade M and Wynne D performed the literature review; Halphen Jr J, Dayal YS, Laurie C, Ahmadzade M, and Wynne D drafted the manuscript; Ghasemi-Rad M supervised the work and conducted critical review and editing; and all authors reviewed the manuscript and approved the final submitted version.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Mohammad Ghasemi-Rad, MD, Department of Radiology, Section of Vascular and Interventional Radiology, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, United States. mohammad.ghasemirad@bcm.edu
Received: February 24, 2026 Revised: March 17, 2026 Accepted: May 6, 2026 Published online: June 28, 2026 Processing time: 128 Days and 2.9 Hours
Core Tip
Core Tip: The pathogenesis of hepatic encephalopathy (HE) following transjugular intrahepatic portosystemic shunt (TIPS) placement remains incompletely understood. While hyperammonemia is classically implicated as the driver of HE development, Zhuang et al also suggest that postoperative hemodynamic changes play a key role. Using three-dimensional arterial spin labeling and resting-state functional magnetic resonance imaging, the authors demonstrate brain-region-specific alterations in cerebral blood flow and resting spontaneous brain activity, as measured by amplitude of low-frequency fluctuation, following TIPS placement. Their findings challenge the conventional understanding of post-TIPS placement HE and highlight the diagnostic potential of resting-state functional magnetic resonance imaging for characterizing HE during the early postoperative period.
