Introduction
Patients and methods
Patients
Patient | Sex | Age at time MRI/MRS | Timing of MRS relative to LTx | Cause of liver dysfunction indicating liver transplantation | Encephalopathy score at time of MRS | Other diagnostic information |
---|---|---|---|---|---|---|
Acute liver failure at the time of MRI/MRS | ||||||
1 | F | 5 months | 1 week before | Neonatal cholestasis ex causa ingognita; acute on chronic liver failure | Grade I* | Pyruvate kinase deficiency |
2 | M | 2 years | 1 day before | Acute liver failure due to adenovirus infection | Grade IVa
| |
3 | M | 5 years | 1 week after | Acute liver failure due to hepatopulmonary syndrome | Grade IVb
| Systemic candida infection; biliary atresia |
4 | M | 5 years | 1 day before | Acute/subacute liver failure due to cholangitis | Grade I | |
5 | M | 7 years | Not realized | Acute liver failure, possibly due to edonovirus infection | Grade III | |
No acute liver failure at the time of MRI/MRS | ||||||
6 | F | 3 years | 1 year after | Alagille’s syndrome | None | Periphery pulmonalis stenosis |
7 | M | 4 years | 1.5 years after | Biliary atresia due to cholangitis | None | |
4 | M | 5 years | 2 weeks after | Acute liver failure due to cholangitis | None | |
8 | F | 8 years | 5 years after | Alagille’s syndrome | None | Periphery pulmonalis stenosis |
9 | M | 11 years | 2 weeks after | Biliary atresia | None |
Patient | 1 | 2 | 3 | 4* | 5 | 6 | 7 | 8 | 9 | Reference values |
---|---|---|---|---|---|---|---|---|---|---|
Glx (mmol/l) | ||||||||||
Grey matter | 6.1 | 5.4 | 5.7 | 3.3/2.7 | 4.3 | 2.1 | 2.7 | 2.4 | 2.2 | 1.5–2.0** |
White matter | 5.4 | 3.9 | 4.4 | 2.4/1.9 | 3.1 | 1.2 | 2.3 | 1.7 | 1.2 | 1.0–1.5** |
Lactate (mmol/l) | ||||||||||
Grey matter | 0.9 | 0.7 | 2.7 | 0.8/0.6 | 0.5 | 0.6 | 0.6 | 0.5 | 0.3 | 0–0.5** |
White matter blood | 0.6 | 0.4 | 1.9 | 0.4/0.3 | 0.3 | 0.3 | 0.3 | 0.3 | 0.2 | 0–0.5** |
Ammonia (μmol/l) | 154 | 65 | 234 | 50/30 | 45 | n.d. | n.d. | n.d. | 14 | 15–45 |
Bilirubin (μmol/l) | ||||||||||
Total | 1,272 | 180 | 196 | 257/10 | 163 | 6 | 10 | 6 | 66 | 0–17*** |
Direct | 1,149 | 122 | 116 | 152/3 | 137 | 3 | 6 | 1 | 48 | |
Indirect | 123 | 58 | 80 | 105/7 | 26 | 3 | 4 | 5 | 18 | |
γ-glutamyl transpept-idase (U/l) | 87 | 35 | 26 | 73/185 | 52 | 18 | 100 | 13 | 1,099 | 5–63**** |
Alkaline phosphatase (U/l) | 437 | 196 | 113 | 435/134 | 440 | 164 | 477 | 285 | 1,048 | 22–92*** |
Albumin (g/l) | 33 | 26 | 24 | 35/38 | 35 | 40 | 40 | 42 | 29 | 38–54*** |
ASAT (U/l) | 1437 | 2857 | 222 | 161/16 | 537 | 112 | 76 | 59 | 95 | 10–40**** |
ALAT (U/l) | 437 | 3954 | 212 | 125/16 | 2,026 | 90 | 76 | 41 | 171 | 6–40**** |
Venous pH | 6.99 | 7.42 | 7.27 | 7.55/7.51 | 7.47 | 7.38 | 7.38 | 7.36 | 7.43 | 7.28–7.43 |
Blood lactate (mmol/l) | 13.4 | n.d. | n.d. | 3.2/2.1 | 1.3 | n.d. | n.d. | n.d. | 2.5 | 0.5–2.0 |
MR spectroscopy
Statistical analysis
Results
Acute liver failure (n = 5) | No acute liver failure (n = 5) |
P
| |
---|---|---|---|
Glutamate/glutam. (mmol/l) | |||
Grey matter | 5.4 (3.3–6.1) | 2.4 (2.1–2.7) | 0.009 |
White matter | 3.9 (2.4–5.4) | 1.7 (1.2–2.3) | 0.009 |
Lactate (mmol/l) | |||
Grey matter | 0.8 (0.5–2.7) | 0.6 (0.3–0.6) | 0.056 |
White matter | 0.4 (0.3–1.9) | 0.3 (0.2–0.3) | 0.019 |
Ammonia (μmol/l) | 65 (45–234) | 22 (14–30) | 0.053 |
Bilirubin (μmol/l) | |||
Total | 196 (163–1272) | 8 (6–66) | 0.009 |
Direct | 137 (116–1149) | 3 (1–48) | 0.009 |
Indirect | 80 (26–123) | 5 (3–18) | 0.009 |
γ-glutamyl transpeptidase (U/l) | 52 (26–87) | 100 (13–1099) | 0.602 |
Alkaline phosphatase (U/l) | 435 (113–437) | 285 (134–1048) | 0.753 |
Albumin (g/l) | 33 (24–35) | 40 (29–42) | 0.046 |
ASAT (U/l) | 537 (161–2857) | 76 (16–112) | 0.009 |
ALAT (U/l) | 437 (125–3954) | 76 (16–171) | 0.016 |
Venous pH | 7.42 (6.99–7.55) | 7.38 (7.36–7.51) | 0.917 |