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Abstract #2211

Brain MR Imaging and 1H-MR Spectroscopy Changes in Patients with Extra-Hepatic Portal Vein Obstruction from Early Childhood to Adulthood

Santosh Kumar Yadav1, Sona Saksena1, Anshu Srivastava2, Arti Srivastava1, Vivek A. Saraswat3, Michael A. Thomas4, Ram Kishore S. Rathore5, Rakesh K. Gupta1

1Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India; 2Pediatric gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India; 3Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India; 4Radiological Sciences, UCLA School of Medicine, Los Angeles, CA, Los Angeles, CA, United States; 5Mathematics and Statistics, Indian Institute of technology Kanpur, Kanpur, Uttar Pradesh, India


Sixty-three patients with EHPVO having different age groups with 47 age/sex matched controls were studied. Neuropsychological tests, MR imaging, 1H-MR Spectroscopy and blood-ammonia estimation were performed in all subjects. 40% EHPVO patients had MHE who showed significantly increased Mean diffusivity, Glx/Cr, blood-ammonia and GP T1 H in all age groups; however, mIns/Cr was significantly lower only in adults when compared to controls. Mean diffusivity positively correlated with blood-ammonia and Glx/Cr in all age groups. A significant positive correlation was observed between Glx/Cr and blood-ammonia. Increases in Mean diffusivity, Glx/Cr, blood-ammonia and GP T1 H and decrease in mIns/Cr are associated with pathogenesis of MHE in adults with EHPVO. No change of cho/Cr in EHPVO may serve as a diagnostic marker for its differentiation from cirrhosis induced MHE. A significant positive correlation among blood ammonia, Glx/Cr and mean diffusivity indicates that hyperammonia contributes to the generalized low grade cerebral edema.