Ignite Creation Date:
2025-12-25 @ 3:33 AM
Ignite Modification Date:
2025-12-26 @ 2:15 AM
Study NCT ID:
NCT04131205
Status:
UNKNOWN
Last Update Posted:
2019-10-18
First Post:
2019-10-15
Is NOT Gene Therapy:
False
Has Adverse Events:
False
Brief Title:
Role of MRI in Detection of Minimal Hepatic Encephalopathy
Sponsor:
Organization:
Raw JSON
{'hasResults': False, 'derivedSection': {'miscInfoModule': {'versionHolder': '2025-12-24'}, 'conditionBrowseModule': {'meshes': [{'id': 'D006501', 'term': 'Hepatic Encephalopathy'}], 'ancestors': [{'id': 'D017093', 'term': 'Liver Failure'}, {'id': 'D048550', 'term': 'Hepatic Insufficiency'}, {'id': 'D008107', 'term': 'Liver Diseases'}, {'id': 'D004066', 'term': 'Digestive System Diseases'}, {'id': 'D001928', 'term': 'Brain Diseases, Metabolic'}, {'id': 'D001927', 'term': 'Brain Diseases'}, {'id': 'D002493', 'term': 'Central Nervous System Diseases'}, {'id': 'D009422', 'term': 'Nervous System Diseases'}, {'id': 'D008659', 'term': 'Metabolic Diseases'}, {'id': 'D009750', 'term': 'Nutritional and Metabolic Diseases'}]}, 'interventionBrowseModule': {'meshes': [{'id': 'D008279', 'term': 'Magnetic Resonance Imaging'}], 'ancestors': [{'id': 'D014054', 'term': 'Tomography'}, {'id': 'D003952', 'term': 'Diagnostic Imaging'}, {'id': 'D019937', 'term': 'Diagnostic Techniques and Procedures'}, {'id': 'D003933', 'term': 'Diagnosis'}]}}, 'protocolSection': {'designModule': {'studyType': 'OBSERVATIONAL', 'designInfo': {'timePerspective': 'PROSPECTIVE', 'observationalModel': 'CASE_CONTROL'}, 'enrollmentInfo': {'type': 'ESTIMATED', 'count': 40}, 'patientRegistry': False}, 'statusModule': {'overallStatus': 'UNKNOWN', 'lastKnownStatus': 'RECRUITING', 'startDateStruct': {'date': '2019-06-01', 'type': 'ACTUAL'}, 'expandedAccessInfo': {'hasExpandedAccess': False}, 'statusVerifiedDate': '2019-10', 'completionDateStruct': {'date': '2023-06-01', 'type': 'ESTIMATED'}, 'lastUpdateSubmitDate': '2019-10-16', 'studyFirstSubmitDate': '2019-10-15', 'studyFirstSubmitQcDate': '2019-10-16', 'lastUpdatePostDateStruct': {'date': '2019-10-18', 'type': 'ACTUAL'}, 'studyFirstPostDateStruct': {'date': '2019-10-18', 'type': 'ACTUAL'}, 'primaryCompletionDateStruct': {'date': '2023-06-01', 'type': 'ESTIMATED'}}, 'outcomesModule': {'primaryOutcomes': [{'measure': 'Structural and Functional Changes in Brain Structures with Magnetic Resonance Imaging', 'timeFrame': '2 hours', 'description': 'GABA levels and other neurotransmitters with respect to the tissue water signal and corrected for tissue composition.'}]}, 'oversightModule': {'oversightHasDmc': False, 'isFdaRegulatedDrug': False, 'isFdaRegulatedDevice': False}, 'conditionsModule': {'conditions': ['Liver Cirrhoses', 'Hepatic Encephalopathy']}, 'referencesModule': {'references': [{'pmid': '25015420', 'type': 'BACKGROUND', 'citation': 'American Association for the Study of Liver Diseases; European Association for the Study of the Liver. Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases. J Hepatol. 2014 Sep;61(3):642-59. doi: 10.1016/j.jhep.2014.05.042. Epub 2014 Jul 8. No abstract available.'}, {'pmid': '28536616', 'type': 'BACKGROUND', 'citation': 'Bartolic M, Vovk A, Suput D. Effects of NH4CL application and removal on astrocytes and endothelial cells. Cell Mol Biol Lett. 2016 Aug 23;21:13. doi: 10.1186/s11658-016-0011-3. eCollection 2016.'}, {'pmid': '15779041', 'type': 'BACKGROUND', 'citation': 'Binesh N, Huda A, Bugbee M, Gupta R, Rasgon N, Kumar A, Green M, Han S, Thomas MA. Adding another spectral dimension to 1H magnetic resonance spectroscopy of hepatic encephalopathy. J Magn Reson Imaging. 2005 Apr;21(4):398-405. doi: 10.1002/jmri.20291.'}, {'pmid': '23419824', 'type': 'BACKGROUND', 'citation': 'Blachier M, Leleu H, Peck-Radosavljevic M, Valla DC, Roudot-Thoraval F. The burden of liver disease in Europe: a review of available epidemiological data. J Hepatol. 2013 Mar;58(3):593-608. doi: 10.1016/j.jhep.2012.12.005.'}, {'pmid': '10365817', 'type': 'BACKGROUND', 'citation': 'Bustamante J, Rimola A, Ventura PJ, Navasa M, Cirera I, Reggiardo V, Rodes J. Prognostic significance of hepatic encephalopathy in patients with cirrhosis. J Hepatol. 1999 May;30(5):890-5. doi: 10.1016/s0168-8278(99)80144-5.'}, {'pmid': '23168529', 'type': 'BACKGROUND', 'citation': 'Chavarria L, Alonso J, Garcia-Martinez R, Simon-Talero M, Ventura-Cots M, Ramirez C, Torrens M, Vargas V, Rovira A, Cordoba J. Brain magnetic resonance spectroscopy in episodic hepatic encephalopathy. J Cereb Blood Flow Metab. 2013 Feb;33(2):272-7. doi: 10.1038/jcbfm.2012.173. Epub 2012 Nov 21.'}, {'pmid': '9931268', 'type': 'BACKGROUND', 'citation': 'Dale AM, Fischl B, Sereno MI. Cortical surface-based analysis. I. Segmentation and surface reconstruction. Neuroimage. 1999 Feb;9(2):179-94. doi: 10.1006/nimg.1998.0395.'}, {'pmid': '28660152', 'type': 'BACKGROUND', 'citation': 'Elwir S, Rahimi RS. Hepatic Encephalopathy: An Update on the Pathophysiology and Therapeutic Options. J Clin Transl Hepatol. 2017 Jun 28;5(2):142-151. doi: 10.14218/JCTH.2016.00069. Epub 2017 May 4.'}, {'pmid': '11870389', 'type': 'BACKGROUND', 'citation': 'Ferenci P, Lockwood A, Mullen K, Tarter R, Weissenborn K, Blei AT. Hepatic encephalopathy--definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998. Hepatology. 2002 Mar;35(3):716-21. doi: 10.1053/jhep.2002.31250.'}, {'pmid': '10984517', 'type': 'BACKGROUND', 'citation': 'Fischl B, Dale AM. Measuring the thickness of the human cerebral cortex from magnetic resonance images. Proc Natl Acad Sci U S A. 2000 Sep 26;97(20):11050-5. doi: 10.1073/pnas.200033797.'}, {'pmid': '11832223', 'type': 'BACKGROUND', 'citation': 'Fischl B, Salat DH, Busa E, Albert M, Dieterich M, Haselgrove C, van der Kouwe A, Killiany R, Kennedy D, Klaveness S, Montillo A, Makris N, Rosen B, Dale AM. Whole brain segmentation: automated labeling of neuroanatomical structures in the human brain. Neuron. 2002 Jan 31;33(3):341-55. doi: 10.1016/s0896-6273(02)00569-x.'}, {'pmid': '15501102', 'type': 'BACKGROUND', 'citation': 'Fischl B, Salat DH, van der Kouwe AJ, Makris N, Segonne F, Quinn BT, Dale AM. Sequence-independent segmentation of magnetic resonance images. Neuroimage. 2004;23 Suppl 1:S69-84. doi: 10.1016/j.neuroimage.2004.07.016.'}, {'pmid': '9931269', 'type': 'BACKGROUND', 'citation': 'Fischl B, Sereno MI, Dale AM. Cortical surface-based analysis. II: Inflation, flattening, and a surface-based coordinate system. Neuroimage. 1999 Feb;9(2):195-207. doi: 10.1006/nimg.1998.0396.'}, {'pmid': '10619420', 'type': 'BACKGROUND', 'citation': 'Fischl B, Sereno MI, Tootell RB, Dale AM. High-resolution intersubject averaging and a coordinate system for the cortical surface. Hum Brain Mapp. 1999;8(4):272-84. doi: 10.1002/(sici)1097-0193(1999)8:43.0.co;2-4.'}, {'pmid': '14654453', 'type': 'BACKGROUND', 'citation': 'Fischl B, van der Kouwe A, Destrieux C, Halgren E, Segonne F, Salat DH, Busa E, Seidman LJ, Goldstein J, Kennedy D, Caviness V, Makris N, Rosen B, Dale AM. Automatically parcellating the human cerebral cortex. Cereb Cortex. 2004 Jan;14(1):11-22. doi: 10.1093/cercor/bhg087.'}, {'pmid': '19509075', 'type': 'BACKGROUND', 'citation': 'Foerster BR, Conklin LS, Petrou M, Barker PB, Schwarz KB. Minimal hepatic encephalopathy in children: evaluation with proton MR spectroscopy. AJNR Am J Neuroradiol. 2009 Sep;30(8):1610-3. doi: 10.3174/ajnr.A1652. Epub 2009 Jun 9.'}, {'pmid': '27557303', 'type': 'BACKGROUND', 'citation': 'Ge PS, Runyon BA. Treatment of Patients with Cirrhosis. N Engl J Med. 2016 Aug 25;375(8):767-77. doi: 10.1056/NEJMra1504367. No abstract available.'}, {'pmid': '8985263', 'type': 'BACKGROUND', 'citation': 'Geissler A, Lock G, Frund R, Held P, Hollerbach S, Andus T, Scholmerich J, Feuerbach S, Holstege A. Cerebral abnormalities in patients with cirrhosis detected by proton magnetic resonance spectroscopy and magnetic resonance imaging. Hepatology. 1997 Jan;25(1):48-54. doi: 10.1053/jhep.1997.v25.pm0008985263.'}, {'pmid': '28150876', 'type': 'BACKGROUND', 'citation': 'Harris AD, Saleh MG, Edden RA. Edited 1 H magnetic resonance spectroscopy in vivo: Methods and metabolites. Magn Reson Med. 2017 Apr;77(4):1377-1389. doi: 10.1002/mrm.26619. Epub 2017 Feb 2.'}, {'pmid': '25459346', 'type': 'BACKGROUND', 'citation': 'Hassan EA, Abd El-Rehim AS, Seifeldein GS, Shehata GA. Minimal hepatic encephalopathy in patients with liver cirrhosis: magnetic resonance spectroscopic brain findings versus neuropsychological changes. Arab J Gastroenterol. 2014 Sep-Dec;15(3-4):108-13. doi: 10.1016/j.ajg.2014.09.003. Epub 2014 Nov 11.'}, {'pmid': '7926510', 'type': 'BACKGROUND', 'citation': 'Haussinger D, Laubenberger J, vom Dahl S, Ernst T, Bayer S, Langer M, Gerok W, Hennig J. Proton magnetic resonance spectroscopy studies on human brain myo-inositol in hypo-osmolarity and hepatic encephalopathy. Gastroenterology. 1994 Nov;107(5):1475-80. doi: 10.1016/0016-5085(94)90552-5.'}, {'pmid': '9136840', 'type': 'BACKGROUND', 'citation': 'Laubenberger J, Haussinger D, Bayer S, Gufler H, Hennig J, Langer M. Proton magnetic resonance spectroscopy of the brain in symptomatic and asymptomatic patients with liver cirrhosis. Gastroenterology. 1997 May;112(5):1610-6. doi: 10.1016/s0016-5085(97)70043-x.'}, {'pmid': '10445551', 'type': 'BACKGROUND', 'citation': 'Lee JH, Seo DW, Lee YS, Kim ST, Mun CW, Lim TH, Min YI, Suh DJ. Proton magnetic resonance spectroscopy (1H-MRS) findings for the brain in patients with liver cirrhosis reflect the hepatic functional reserve. Am J Gastroenterol. 1999 Aug;94(8):2206-13. doi: 10.1111/j.1572-0241.1999.01228.x.'}, {'pmid': '19546351', 'type': 'BACKGROUND', 'citation': 'Long LL, Li XR, Huang ZK, Jiang YM, Fu SX, Zheng W. Relationship between changes in brain MRI and (1)H-MRS, severity of chronic liver damage, and recovery after liver transplantation. Exp Biol Med (Maywood). 2009 Sep;234(9):1075-85. doi: 10.3181/0903-RM-118. Epub 2009 Jun 22.'}, {'pmid': '29427496', 'type': 'BACKGROUND', 'citation': 'Marcellin P, Kutala BK. Liver diseases: A major, neglected global public health problem requiring urgent actions and large-scale screening. Liver Int. 2018 Feb;38 Suppl 1:2-6. doi: 10.1111/liv.13682.'}, {'pmid': '15655660', 'type': 'BACKGROUND', 'citation': 'Mechtcheriakov S, Schocke M, Kugener A, Graziadei IW, Mattedi M, Hinterhuber H, Vogel W, Marksteiner J. Chemical shift magnetic resonance spectroscopy of cingulate grey matter in patients with minimal hepatic encephalopathy. Neuroradiology. 2005 Jan;47(1):27-34. doi: 10.1007/s00234-004-1298-8. Epub 2005 Jan 18.'}, {'pmid': '16687536', 'type': 'BACKGROUND', 'citation': 'Miese F, Kircheis G, Wittsack HJ, Wenserski F, Hemker J, Modder U, Haussinger D, Cohnen M. 1H-MR spectroscopy, magnetization transfer, and diffusion-weighted imaging in alcoholic and nonalcoholic patients with cirrhosis with hepatic encephalopathy. AJNR Am J Neuroradiol. 2006 May;27(5):1019-26.'}, {'pmid': '30302043', 'type': 'BACKGROUND', 'citation': 'Ochoa-Sanchez R, Rose CF. Pathogenesis of Hepatic Encephalopathy in Chronic Liver Disease. J Clin Exp Hepatol. 2018 Sep;8(3):262-271. doi: 10.1016/j.jceh.2018.08.001. Epub 2018 Aug 18.'}, {'pmid': '26359122', 'type': 'BACKGROUND', 'citation': 'Oeltzschner G, Butz M, Baumgarten TJ, Hoogenboom N, Wittsack HJ, Schnitzler A. Low visual cortex GABA levels in hepatic encephalopathy: links to blood ammonia, critical flicker frequency, and brain osmolytes. Metab Brain Dis. 2015 Dec;30(6):1429-38. doi: 10.1007/s11011-015-9729-2. Epub 2015 Sep 11.'}, {'pmid': '17006913', 'type': 'RESULT', 'citation': 'Albrecht J, Norenberg MD. Glutamine: a Trojan horse in ammonia neurotoxicity. Hepatology. 2006 Oct;44(4):788-94. doi: 10.1002/hep.21357.'}]}, 'descriptionModule': {'briefSummary': 'Introduction Liver cirrhosis (LC) is irreversible fibrosis of the liver (1) and it remains a public health problem. One of the complications of the cirrhosis is hepatic encephalopathy (HE) which is defined as brain dysfunction caused by liver insufficiency. Pathophysiological mechanisms of HE are complex and multifactorial. Recognition of beginning stages of HE, such as minimal HE (mHE) is of most importance.\n\nObjectives and originality of the project Diagnosis of mHE can be challenging, time-consuming and, at least to some extent, subjective. This project will assess the role of magnetic resonance (MR) in mHE diagnosis with emphasis on multimodal imaging technique. With advanced magnetic resonance (MR) techniques, in-vivo detection of intracellular water content, estimation pH and metabolites levels with millimolar concentrations can be easily performed. This will offer to explore possible pathophysiological mechanisms of HE and to evaluate the results from previous, studies that were mainly performed on animal models or cell cultures.\n\nBy our best knowledge, multimodal MR approach as the investigators propose in this application has not been yet performed. The investigators will use advanced MR techniques which are currently not available in the clinical setting and require multicenter collaboration.\n\nMethods The investigators will include 10-20 patients of both genders with hyperammonemia and mHE and 10-20 patients of both genders with HE. Diagnosis of HE will be made based on results of validated neuropsychiatric test. Age-matched and gender-matched control group with no gastrointestinal, neurological or psychiatric complaints and normal levels of ammonia in the blood. Patients with mHE/HE will be included from outpatient clinic of the Department of gastroenterology, University Medical Centre (UMC) Ljubljana. Healthy controls (HC) will be invited to join via internet advertisement. Contraindications for HC will include gastrointestinal (emphasis on liver disease), neurological or psychiatric complaints. Grade of mHE/HE will be classified according to West-Haven (WH) classification. Patients with different degree of liver cirrhosis, which will be scored with the Child-Pugh (CP) score, and with no contraindications for MR (e.g. presence of metal in body) will be included. Blood levels of liver enzymes and ammonia will be measured in all participants. MR scanning will include: T1- and T2-weighted MR, MRS (MEGA-PRESS and PRESS) in two voxels: striatum and cerebellum. Location will be double-checked by voxel position screenshots. Analysis, with voxel-positioning error compensation will be performed in Gannet (www.gabamrs.com). Moreover, high resolution diffusion weighted imaging (DWI), diffusion kurtosis imaging (DKI), quantitative susceptibility mapping (QSM) will be performed in brain as well. Liver QSM will be executed to assess iron load.'}, 'eligibilityModule': {'sex': 'ALL', 'stdAges': ['ADULT', 'OLDER_ADULT'], 'maximumAge': '85 Years', 'minimumAge': '18 Years', 'samplingMethod': 'PROBABILITY_SAMPLE', 'studyPopulation': 'We will include 10-20 patients of both genders with signs of hepatic encephalopathy and 10-20 patients of both genders without HE. Diagnosis of HE will be made based on results of validated neuropsychiatric test. Age-matched and gender-matched control group with no gastrointestinal, neurological or psychiatric complaints and normal levels of ammonia in the blood.', 'healthyVolunteers': True, 'eligibilityCriteria': 'Inclusion Criteria:\n\n* Known liver disease/cirrhosis\n\nExclusion Criteria:\n\n* Pregnancy, non compatible material with MRI'}, 'identificationModule': {'nctId': 'NCT04131205', 'briefTitle': 'Role of MRI in Detection of Minimal Hepatic Encephalopathy', 'organization': {'class': 'OTHER', 'fullName': 'University Medical Centre Ljubljana'}, 'officialTitle': 'Role of Magnetic Resonance Imaging in Detection of Minimal Hepatic Encephalopathy', 'orgStudyIdInfo': {'id': 'HepaticEncephalopathy'}}, 'armsInterventionsModule': {'armGroups': [{'label': 'Minimal Hepatic Encephalopathy', 'description': 'Patients with hyperammonemia and minimal hepatic encephalopathy', 'interventionNames': ['Diagnostic Test: Magnetic Resonance Imaging']}, {'label': 'Control', 'description': 'Healthy controls', 'interventionNames': ['Diagnostic Test: Magnetic Resonance Imaging']}], 'interventions': [{'name': 'Magnetic Resonance Imaging', 'type': 'DIAGNOSTIC_TEST', 'otherNames': ['Ammonia Levels', 'Child Pugh Score', 'West-Haven grade of Hepatic Encephalopathy'], 'description': 'We will assess the role of magnetic resonance (MR) in mHE diagnosis with emphasis on multimodal imaging technique', 'armGroupLabels': ['Control', 'Minimal Hepatic Encephalopathy']}]}, 'contactsLocationsModule': {'locations': [{'zip': '1000', 'city': 'Ljubljana', 'status': 'RECRUITING', 'country': 'Slovenia', 'contacts': [{'name': 'Sebastian Stefanovic, M.D.', 'role': 'CONTACT', 'email': 'sebastian.stefanovic@gmail.com', 'phone': '0038615224166'}, {'name': 'Marjana Turk Jerovsek, M.D.', 'role': 'CONTACT', 'email': 'marjanca88@gmail.com', 'phone': '0038615224166'}], 'facility': 'Department of Gastroenterology and Hepatology, University Medical Centre Ljubljana', 'geoPoint': {'lat': 46.05108, 'lon': 14.50513}}], 'centralContacts': [{'name': 'Gasper Zupan, M.D.', 'role': 'CONTACT', 'email': 'gasper.zupan@mf.uni-lj.si', 'phone': '0038615437826'}, {'name': 'Sebastian Stefanovic, M.D.', 'role': 'CONTACT', 'email': 'sebastian.stefanovic@gmail.com'}], 'overallOfficials': [{'name': 'Dusan Suput, M.D.', 'role': 'STUDY_CHAIR', 'affiliation': 'Medical Faculty of Ljubljana'}, {'name': 'Borut Stabuc, M.D.', 'role': 'STUDY_CHAIR', 'affiliation': 'Department of Gastroenterology and Hepatology, University Medical Centre Ljubljana'}]}, 'ipdSharingStatementModule': {'ipdSharing': 'NO'}, 'sponsorCollaboratorsModule': {'leadSponsor': {'name': 'University Medical Centre Ljubljana', 'class': 'OTHER'}, 'collaborators': [{'name': 'University of Ljubljana, Faculty of Medicine', 'class': 'OTHER'}, {'name': 'Medical University of Graz', 'class': 'OTHER'}, {'name': 'Johns Hopkins University', 'class': 'OTHER'}], 'responsibleParty': {'type': 'PRINCIPAL_INVESTIGATOR', 'investigatorTitle': 'Clinical Investigator', 'investigatorFullName': 'Sebastian Stefanovic, MD', 'investigatorAffiliation': 'University Medical Centre Ljubljana'}}}}