We investigated whether motor system in the brain shows altered functional connectivity and what the anatomical basis behind it is in patients with hepatic myelopathy (HM) after transjugular intrahepatic portosystemic shunt (TIPS), a rare and likely overlooked complication in chronic liver disease patients with portosystemic shunts characterized by severe and mostly irreversible neurologic symptoms. HM patients exhibited hypoconnectivity between the right SMA and right insula, which revealed decreased gray matter volume. The positive correlation was observed between the strength of this connectivity and folic acid level in HM patients, which could discriminate HM from Non-HM with a high level of accuracy.
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