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Early Primary Biliary Cholangitis is Characterised by Brain Abnormalities on Cerebral Magnetic Resonance Imaging

Lookup NU author(s): Dr Jess Dyson, Professor David Jones



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


BackgroundBrain change can occur in primary biliary cholangitis (PBC), potentially as a result of cholestatic and/or inflammatory processes. This change is linked to systemic symptoms of fatigue and cognitive impairment.AimTo identify whether brain change occurs early in PBC. If the change develops early and is progressive, it may explain the difficulty in treating these symptoms.MethodsEarly disease brain change was explored in 13 patients with newly diagnosed biopsy-proven precirrhotic PBC using magnetisation transfer, diffusion-weighted imaging and 1H magnetic resonance spectroscopy. Results were compared to 17 healthy volunteers.ResultsCerebral magnetisation transfer ratios were reduced in early PBC, compared to healthy volunteers, in the thalamus, putamen and head of caudate with no greater reduction in patients with greater symptom severity. Mean apparent diffusion coefficients were increased in the thalamus only. No 1H magnetic resonance spectroscopy abnormalities were seen. Serum manganese levels were elevated in all PBC patients, but no relationship was seen with imaging or symptom parameters. There were no correlations between neuroimaging data, laboratory data, symptom severity scores or age.ConclusionsThis is the first study to be performed in this precirrhotic patient population, and we have highlighted that neuroimaging changes are present at a much earlier stage than previously demonstrated. The neuroimaging abnormalities suggest that the brain changes seen in PBC occur early in the pathological process, even before significant liver damage has occurred. If such changes are linked to symptom pathogenesis, this could have important implications for the timing of second-line-therapy use.

Publication metadata

Author(s): Grover VPB, Southern L, Dyson JK, Kim JU, Crossey MME, Wylezinska-Arridge M, Patel N, Fitzpatrick JA, Bal-Bok A, Waldman AD, Mells GF, Chapman RW, Jones DEJ, Taylor-Robinson SD

Publication type: Article

Publication status: Published

Journal: Alimentary Pharmacology & Therapeutics

Year: 2016

Volume: 44

Issue: 9

Pages: 936-945

Print publication date: 01/11/2016

Online publication date: 08/09/2016

Acceptance date: 08/09/2016

Date deposited: 21/11/2016

ISSN (print): 0269-2813

ISSN (electronic): 1365-2036

Publisher: Wiley-Blackwell Publishing Ltd.


DOI: 10.1111/apt.13797


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