中文摘要：

目的 利用DWI和1H-MRS研究肝性脑病（hepatic encephalopathy,HE）患者脑内水肿和代谢化合物的变化及其相关性.方法 选择33例经临床和（或）手术病理确诊为肝硬化（其中13例并发肝性脑病）的患者和健康志愿者20名进行DWI和1H-MRS检查.分别计算脑内6个部位（包括灰白质）的表观弥散系数（ADC）值及测量质子波谱中所观察到的代谢产物的峰高,以总肌酸（Cr）为参照计算峰高的比值,进行相对定量分析.结果 各部位 ADC值随着 HE的严重程度增高,各组间ADC值在顶、枕叶差异有统计学意义,其余部位未见显著性差异.质子波谱分析显示肝硬化组和HE组波谱可见不同程度的Cho、mI峰降低和Glx峰升高,其中Glx峰在HE组比肝硬化组更常见且明显.肝硬化病人ADC值变化与mI及Glx峰间有明显相关性.结论 降低的mI峰、升高的Glx峰和ADC值提示肝性脑病存在轻度脑水肿,可能与脑内弥漫的星形细胞肿胀和血脑屏障受损有关.

英文摘要：

Objective To study the relationships between hydrocephalus and metabolites in the patients with hepatic encephalopathy （HE） ,by using the techniques of MR diffusion weighted imaging （DWI） and 1H magnetic resonance spectroscopy （1H--MRS）. Methods 33 patients （13 patients with HE） who were diagnosed as liver cirrhosis via either clinical or operationally pathological diagnosis, and 20 healthy volunteers underwent MR DWI and 1 H MRS examinations. The apparent diffusion coefficients （ADC） of 6 brain parts （including gray and white matters） were calculated, and the ratio of peak heights of various metabolites observed in the measurement of proton spectrum over the total creatine （Cr） were also calculated and processed relatively quantified analysis. Results ADC values increased with the severity of HE , and there were significant differences in ADC values in parietal and occipital lobes among these groups, but no significant changes in the rest brain parts. Cho and mI peak decreased and Glx peak increased in both cirrhosis and HE,particularly,the alteration of Glx peak was more significant in HE group than cirrhosis group. Moreover, there was significant correlation between the changes of ADC value and mI and Glx peak heights in cirrhosis. Conclusion The decreased mI peak,increased Glx peak and ADC value may prompt that there is slight hydrocephalus in HE,which may be induced by the damage of blood brain barrier and swelling of astrocytes inside the brain.