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

Table 1 Demographical and clinical data of patients, mean ± SD

Protocols	HC	Before TIPS (n = 18)	After TIPS		P value
			1 month (n = 12)	3 months (n = 8)
Sex (male/female)	12/6	15/3	11/1	7/1	> 0.05a
Age (years)	59.56 ± 1.97	57.61 ± 1.68	56.58 ± 2.01	58.25 ± 2.33	> 0.05b
Child-Pugh scores	5.00 ± 0.00	7.61 ± 1.58	7.42 ± 1.38	8.38 ± 1.69	< 0.001c
Child-Pugh class		5A/11B/2C	2A/8B/2C	2A/3B/3C
Ammonia level (μmol/L)	17.20 ± 2.11	31.08 ± 10.61	37.18 ± 12.78	32.96 ± 8.19	< 0.001c
NCT-A (seconds)	35.94 ± 5.65	51.22 ± 4.34	53.33 ± 5.28	58.75 ± 7.93	< 0.001c
DSST (score)	53.94 ± 1.72	33.89 ± 8.76	32.58 ± 7.19	31.88 ± 5.33	< 0.001c
Portal pressure (cmH2O)		34.93 ± 2.49	23.87 ± 1.99		< 0.001c
HE or MHE			3 HE
Etiology	9 hepatitis cirrhosis/2 alcoholic cirrhosis/7 other causes including autoimmune liver disease
TIPS indication	16 bleeding/2 refractory ascites

^aP > 0.05 was obtained using the χ² test.

^bP > 0.05 was obtained using two independent sample t-tests and paired t-tests.

^cP < 0.001 was obtained using two independent sample t-tests.

NCT-A: Number Connection Test Part A; DSST: Digit Symbol Substitution Test; HE: Hepatic encephalopathy; MHE: Minimal hepatic encephalopathy; TIPS: Transjugular intrahepatic portosystemic shunts; HC: Healthy control group.

Table 2 Regions with significant differences showing cerebral blood flowand amplitude of low-frequency fluctuation

Group	Brain regions	MNI coordinates (mm)			Volume (mm3)	Peak (t-value)
		X	Y	Z
Comparison results of CBF differences
Before-HC	R. orbitofrontal superior gyrus	9	66	-12	1056	-4.62
	L. superior temporal gyrus	-60	-27	18	537	-3.96
1 m-before	L. fusiform gyrus	-30	-39	-18	5280	+6.56
3 m-1 m	R. fusiform gyrus	39	-33	-21	512	-4.39
	L. angular gyrus	-45	-63	51	587	+7.93
Comparison results of ALFF differences
Before-HC	L. superior temporal gyrus	-39	-33	12	1502	-6.68
	L. opercular part of inferior frontal gyrus	-48	9	21	213	-6.36
	R. precuneus	15	-60	21	3765	-6.04
1 m-before	L. superior temporal gyrus	-48	-30	21	687	+4.68
3 m-before	L. orbitofrontal superior gyrus	-6	51	-6	298	+5.95
	L. precuneus	-3	-75	51	458	+7.69
3 m-1 m	R. insula	36	-27	18	513	-6.43
	Cerebelum_Crus1_L	-24	-72	-33	851	-6.64

Positive sign in the peak t-score represents increase, and negative sign represents decrease; All P < 0.05, corrected for Gaussian random field. Before: Preoperative transjugular intrahepatic portosystemic shunts; HC: Healthy control group; 1 m: Postoperative transjugular intrahepatic portosystemic shunts at 1 month; 3 m: Postoperative transjugular intrahepatic portosystemic shunts at 3 months; CBF: Cerebral blood flow; ALFF: Amplitude of low-frequency fluctuation; R.: Right; L.: Left; MNI: Montreal Neurological Institute.