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Lupescu IC, Iacob S, Lupescu IG, Pietrareanu C, Gheorghe L. Assessment of Minimal Hepatic Encephalopathy with Brain MRI and EncephalApp Stroop Test. Maedica (Bucur) 2023; 18:4-11. [PMID: 37266463 PMCID: PMC10231161 DOI: 10.26574/maedica.2023.18.1.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Background: Minimal hepatic encephalopathy (MHE) consists of subtle cognitive deficits that are not apparent on a standard neurological examination. Minimal hepatic encephalopathy has been reported in up to 80% of cirrhotic patients and is associated with decreased job performance, poor driving performance, impaired quality of life, and poor survival. In parallel, brain magnetic resonance imaging (MRI) abnormalities are known to occur in liver cirrhotic patients in the form of T1 globus pallidus hyperintensities. In recent years, a new psychometric test for diagnosing MHE has been developed as an app for smartphones and tablets (EncephalApp Stroop test). A translated version of the app is available in Romanian language. Aim:To use EncephalApp Stroop test for MHE diagnosis in our cirrhotic patients; to describe the main brain MRI abnormalities encountered in these patients; and to establish if Stroop test results correlate with imaging findings, clinical neurologic findings, and liver function parameters or prognosis. Material and methods:Cross-sectional study over a one-year period, involving 30 adult patients with liver cirrhosis. Subjects were evaluated through a standard neurological examination, psychometric testing using EncephalApp Stroop test, electroencephalogram and brain MRI. In parallel, 40 adult healthy controls were also recruited and evaluated with the EncephalApp Stroop test using the same methodology. Results:Age distribution was similar between the two groups (p=0.6). The mean age of patients was 50±10 years and that of controls 51±12 years. Mean Stroop result was 171±26 seconds for the patient group and 143±20 seconds for the control group (p<0.0001). There was a direct correlation between Stroop test results and age in the control group (R=0.69, p<0.0001) but not also in the patient group (R=0.28, p=0.13). Statistically significant results were obtained by using the Fischer exact test for both cut-off values: 145 seconds in patients < 45-year-old (p<0.001) and 190 seconds in those ≥45 years-old (p=0.03). MRI T1-hyperintensities of the basal ganglia, blood ammonia levels and electroencephalographic changes were not associated with poorer results. Conclusion:Our pilot study, although small, confirmed that patients with liver cirrhosis may have subtle deficits in cognitive areas like attention, concentration or reaction time. This can be assessed easily with the EncephalApp Stroop test which is readily available for use on smartphones or tablets.
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Affiliation(s)
- I C Lupescu
- Neurology Department, Fundeni Clinical Institute, Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - S Iacob
- Gastroenterology and Hepatology Department, Fundeni Clinical Institute, Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - I G Lupescu
- Radiology and Medical Imaging Department, Fundeni Clinical Institute, Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - C Pietrareanu
- Gastroenterology and Hepatology Department, Fundeni Clinical Institute, Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - L Gheorghe
- Gastroenterology and Hepatology Department, Fundeni Clinical Institute, Bucharest, Romania
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Sporea I, Badea R, Popescu A, Spârchez Z, Sirli RL, Dănilă M, Săndulescu L, Bota S, Calescu DP, Nedelcu D, Brisc C, Ciobâca L, Gheorghe L, Socaciu M, Martie A, Ioaniţescu S, Tamas A, Streba CT, Iordache M, Simionov I, Jinga M, Anghel A, Cijevschi Prelipcean C, Mihai C, Stanciu SM, Stoicescu D, Dumitru E, Pietrareanu C, Bartos D, Manzat Saplacan R, Pârvulescu I, Vădan R, Smira G, Tuţă L, Săftoiu A. Contrast-enhanced ultrasound (CEUS) for the evaluation of focal liver lesions - a prospective multicenter study of its usefulness in clinical practice. Ultraschall Med 2014; 35:259-66. [PMID: 24563420 DOI: 10.1055/s-0033-1355728] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE To assess the value of contrast-enhanced ultrasound (CEUS) for differentiating malignant from benign focal liver lesions (FLLs) and for diagnosing different FLL types. MATERIAL AND METHODS CEUS performed in 14 Romanian centers was prospectively collected between February 2011 and June 2012. The inclusion criteria were: age > 18 years; patients diagnosed with 1 - 3 de novo FLLs on B-mode ultrasound; reference method (computed tomography (CT), magnetic resonance imaging (MRI) or biopsy) available; patient's informed consent. FLL lesions were characterized during CEUS according to the European Federation of Societies for Ultrasound in Medicine and Biology guidelines. For statistical analysis, indeterminate FLLs at CEUS were rated as false classifications. RESULTS A total number of 536 cases were included in the final analysis, 344 malignant lesions (64.2 %) and 192 benign lesions (35.8 %). The reference method was: CT/MRI - 379 cases (70.7 %), pathological exam - 150 cases (27.9 %) and aspiration of liver abscesses - 7 cases (1.4 %). CEUS was conclusive in 89.3 % and inconclusive in 10.7 % of cases. To differentiate between malignant and benign FLLs, CEUS had 85.7 % sensitivity, 85.9 % specificity, 91.6 % positive predictive value, 77.1 % negative predictive value and 85.8 % accuracy. The CEUS accuracy for differentiation between malignant and benign liver lesions was similar in tumors with diameter ≤ 2 cm and those with diameter > 2 cm. CONCLUSION CEUS represents a useful method in clinical practice for differentiating between malignant and benign FLLs detected on standard ultrasonography, and the results of this study are in concordance with previous multicenter studies: DEGUM (Germany) and STIC (France).
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Affiliation(s)
- I Sporea
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy "Victor Babeş" Timişoara, Romania
| | - R Badea
- Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor", University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj Napoca, Romania
| | - A Popescu
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy "Victor Babeş" Timişoara, Romania
| | - Z Spârchez
- Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor", University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj Napoca, Romania
| | - R L Sirli
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy "Victor Babeş" Timişoara, Romania
| | - M Dănilă
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy "Victor Babeş" Timişoara, Romania
| | - L Săndulescu
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
| | - S Bota
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy "Victor Babeş" Timişoara, Romania
| | - D P Calescu
- Department of Gastroenterology, Emergency Hospital Floreasca, Bucharest, Romania
| | - D Nedelcu
- Delta Promedical Hospital, Bucharest, Romania
| | - C Brisc
- Department of Gastroenterology, University of Oradea, Romania
| | - L Ciobâca
- 1st Medical Department, Central Military Emergency University Hospital "Dr. Carol Davila", Bucharest, Romania
| | - L Gheorghe
- IIIrd Department of Gastroenterology and Hepatology, Clinical Institute Fundeni, Bucharest, Romania
| | - M Socaciu
- Regional Institute of Gastroenterology and Hepatology "Prof. Dr. Octavian Fodor", University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj Napoca, Romania
| | - A Martie
- Department of Gastroenterology and Hepatology, University of Medicine and Pharmacy "Victor Babeş" Timişoara, Romania
| | - S Ioaniţescu
- Center of Internal Medicine, Fundeni Clinical Institute, Bucharest, Romania
| | - A Tamas
- Department of Anatomy and Embriology, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj Napoca, Romania
| | - C T Streba
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
| | - M Iordache
- 1st Medical Department, Central Military Emergency University Hospital "Dr. Carol Davila", Bucharest, Romania
| | - I Simionov
- IIIrd Department of Gastroenterology and Hepatology, Clinical Institute Fundeni, Bucharest, Romania
| | - M Jinga
- 1st Medical Department, Central Military Emergency University Hospital "Dr. Carol Davila", Bucharest, Romania
| | - A Anghel
- 1st Medical Department, Central Military Emergency University Hospital "Dr. Carol Davila", Bucharest, Romania
| | - C Cijevschi Prelipcean
- Institute of Gastroenterology and Hepatology, "Grigore T. Popa" University of Medicine and Pharmacy Iaşi, Romania
| | - C Mihai
- Institute of Gastroenterology and Hepatology, "Grigore T. Popa" University of Medicine and Pharmacy Iaşi, Romania
| | - S M Stanciu
- 1st Medical Department, Central Military Emergency University Hospital "Dr. Carol Davila", Bucharest, Romania
| | - D Stoicescu
- 1st Medical Department, Central Military Emergency University Hospital "Dr. Carol Davila", Bucharest, Romania
| | - E Dumitru
- Department of Gastroenterology, University of Constanta, Romania
| | - C Pietrareanu
- IIIrd Department of Gastroenterology and Hepatology, Clinical Institute Fundeni, Bucharest, Romania
| | - D Bartos
- Department of Internal Medicine and Gastroenterology, Emergency Hospital Floreasca, Bucharest, Romania
| | - R Manzat Saplacan
- Ist, Medical Clinic, University of Medicine and Pharmacy "Iuliu Hatieganu" Cluj-Napoca, Cluj Napoca, Romania
| | - I Pârvulescu
- IIIrd Department of Gastroenterology and Hepatology, Clinical Institute Fundeni, Bucharest, Romania
| | - R Vădan
- IIIrd Department of Gastroenterology and Hepatology, Clinical Institute Fundeni, Bucharest, Romania
| | - G Smira
- IIIrd Department of Gastroenterology and Hepatology, Clinical Institute Fundeni, Bucharest, Romania
| | - L Tuţă
- Department of Gastroenterology, University of Constanta, Romania
| | - A Săftoiu
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy, Craiova, Romania
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