Brain Perfusion Scintigraphy in Evaluation of Pathogenesis of Fatigue in Patients with Primary Biliary Cholangitis (PBC) – A Pilot Study

Joanna Raszeja-Wyszomirska; Piotr Zorga; Marcin Kotulski; Bożena Birkenfeld; Piotr Milkiewicz Milkiewicz

doi:doi:10.11648/j.ijcems.20170304.11

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Brain Perfusion Scintigraphy in Evaluation of Pathogenesis of Fatigue in Patients with Primary Biliary Cholangitis (PBC) – A Pilot Study

Joanna Raszeja-Wyszomirska, Piotr Zorga, Marcin Kotulski, Bożena Birkenfeld, Piotr Milkiewicz Milkiewicz

Published in International Journal of Clinical and Experimental Medical Sciences (Volume 3, Issue 4)

Received: 17 July 2017 Accepted: 23 August 2017 Published: 9 September 2017

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Abstract

Primary biliary cholangitis (PBC) is an autoimmune cholestatic liver disease characterized by a breakdown of immune tolerance to mitochondrial and nuclear antigens, causing injury to the biliary epithelial cells. Fatigue is the commonest reported symptom in PBC and has a negative impact on patients' perceived quality of life, often through social isolation. It is unrelated to the severity of liver disease and appears unresponsive to current therapies, including ursodeoxycholic acid and transplantation. Fatigue in PBC is complex, with numerous associated peripheral and central nervous system (CNS) features. Initially, cholestasis causes degenerative CNS change affecting areas of the brain regulating autonomic dysfunction and sleep, and these changes lead directly to some manifestations of fatigue and the associated cognitive impairment. The aim of the study was to examine global cerebral blood flow with brain perfusion scintigraphy SPECT in well-defined group of PBC Caucasian patients with verbally reported fatigue. Twenty consecutive PBC female patients (median age 58.9, ranges 38-80; 4 cirrhotic) with mean duration of the disease 3.3 years, were prospectively enrolled into the study. Fatigue Impact Scale (FIS) questionnaire was administered to every patients at the moment of brain examination. Brain perfusion scintigraphy SPECT was performed after intravenous injection of 760-800 MBq of technetium^99m labeled exametazime (^99mTc –HMPAO). Then patients were examined using double head gamma camera system, and data were analyzed with dedicated nuclear medicine software. In analyzed cohort the median FIS score was 70.5 points (ranges 21-160), which was higher than previously reported. There were no correlation between age of patients at the SPECT/FIS examination, duration of the disease, the presence of liver cirrhosis, Mayo Risk Score, and FIS domains: Cognitive, Physical and Social, as well as with brain blood flow. However, positive correlation between Cognitive dimension of FIS measure and right frontal lobe perfusion impairment assessed with SPECT technic (p<0.05) was found. The results of this study showed that right lobe perfusion impairment might impact brain function in PBC. Cognitive dimension was stage-independent symptom in analyzed cohort, and cognitive impairment might be, in turn, associated with functional brain lesion.

Published in	International Journal of Clinical and Experimental Medical Sciences (Volume 3, Issue 4)
DOI	10.11648/j.ijcems.20170304.11
Page(s)	42-46
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2017. Published by Science Publishing Group

Keywords

Brain Perfusion Scintigraphy, Primary Biliary Cholangitis (PBC), Fatigue, Cognitive Impairment

References

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Joanna Raszeja-Wyszomirska, Piotr Zorga, Marcin Kotulski, Bożena Birkenfeld, Piotr Milkiewicz Milkiewicz. (2017). Brain Perfusion Scintigraphy in Evaluation of Pathogenesis of Fatigue in Patients with Primary Biliary Cholangitis (PBC) – A Pilot Study. International Journal of Clinical and Experimental Medical Sciences, 3(4), 42-46. https://doi.org/10.11648/j.ijcems.20170304.11

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ACS Style

Joanna Raszeja-Wyszomirska; Piotr Zorga; Marcin Kotulski; Bożena Birkenfeld; Piotr Milkiewicz Milkiewicz. Brain Perfusion Scintigraphy in Evaluation of Pathogenesis of Fatigue in Patients with Primary Biliary Cholangitis (PBC) – A Pilot Study. Int. J. Clin. Exp. Med. Sci. 2017, 3(4), 42-46. doi: 10.11648/j.ijcems.20170304.11

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Joanna Raszeja-Wyszomirska, Piotr Zorga, Marcin Kotulski, Bożena Birkenfeld, Piotr Milkiewicz Milkiewicz. Brain Perfusion Scintigraphy in Evaluation of Pathogenesis of Fatigue in Patients with Primary Biliary Cholangitis (PBC) – A Pilot Study. Int J Clin Exp Med Sci. 2017;3(4):42-46. doi: 10.11648/j.ijcems.20170304.11

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@article{10.11648/j.ijcems.20170304.11,
  author = {Joanna Raszeja-Wyszomirska and Piotr Zorga and Marcin Kotulski and Bożena Birkenfeld and Piotr Milkiewicz Milkiewicz},
  title = {Brain Perfusion Scintigraphy in Evaluation of Pathogenesis of Fatigue in Patients with Primary Biliary Cholangitis (PBC) – A Pilot Study},
  journal = {International Journal of Clinical and Experimental Medical Sciences},
  volume = {3},
  number = {4},
  pages = {42-46},
  doi = {10.11648/j.ijcems.20170304.11},
  url = {https://doi.org/10.11648/j.ijcems.20170304.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcems.20170304.11},
  abstract = {Primary biliary cholangitis (PBC) is an autoimmune cholestatic liver disease characterized by a breakdown of immune tolerance to mitochondrial and nuclear antigens, causing injury to the biliary epithelial cells. Fatigue is the commonest reported symptom in PBC and has a negative impact on patients' perceived quality of life, often through social isolation. It is unrelated to the severity of liver disease and appears unresponsive to current therapies, including ursodeoxycholic acid and transplantation. Fatigue in PBC is complex, with numerous associated peripheral and central nervous system (CNS) features. Initially, cholestasis causes degenerative CNS change affecting areas of the brain regulating autonomic dysfunction and sleep, and these changes lead directly to some manifestations of fatigue and the associated cognitive impairment. The aim of the study was to examine global cerebral blood flow with brain perfusion scintigraphy SPECT in well-defined group of PBC Caucasian patients with verbally reported fatigue. Twenty consecutive PBC female patients (median age 58.9, ranges 38-80; 4 cirrhotic) with mean duration of the disease 3.3 years, were prospectively enrolled into the study. Fatigue Impact Scale (FIS) questionnaire was administered to every patients at the moment of brain examination. Brain perfusion scintigraphy SPECT was performed after intravenous injection of 760-800 MBq of technetium99m labeled exametazime (99mTc –HMPAO). Then patients were examined using double head gamma camera system, and data were analyzed with dedicated nuclear medicine software. In analyzed cohort the median FIS score was 70.5 points (ranges 21-160), which was higher than previously reported. There were no correlation between age of patients at the SPECT/FIS examination, duration of the disease, the presence of liver cirrhosis, Mayo Risk Score, and FIS domains: Cognitive, Physical and Social, as well as with brain blood flow. However, positive correlation between Cognitive dimension of FIS measure and right frontal lobe perfusion impairment assessed with SPECT technic (p<0.05) was found. The results of this study showed that right lobe perfusion impairment might impact brain function in PBC. Cognitive dimension was stage-independent symptom in analyzed cohort, and cognitive impairment might be, in turn, associated with functional brain lesion.},
 year = {2017}
}

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TY  - JOUR
T1  - Brain Perfusion Scintigraphy in Evaluation of Pathogenesis of Fatigue in Patients with Primary Biliary Cholangitis (PBC) – A Pilot Study
AU  - Joanna Raszeja-Wyszomirska
AU  - Piotr Zorga
AU  - Marcin Kotulski
AU  - Bożena Birkenfeld
AU  - Piotr Milkiewicz Milkiewicz
Y1  - 2017/09/09
PY  - 2017
N1  - https://doi.org/10.11648/j.ijcems.20170304.11
DO  - 10.11648/j.ijcems.20170304.11
T2  - International Journal of Clinical and Experimental Medical Sciences
JF  - International Journal of Clinical and Experimental Medical Sciences
JO  - International Journal of Clinical and Experimental Medical Sciences
SP  - 42
EP  - 46
PB  - Science Publishing Group
SN  - 2469-8032
UR  - https://doi.org/10.11648/j.ijcems.20170304.11
AB  - Primary biliary cholangitis (PBC) is an autoimmune cholestatic liver disease characterized by a breakdown of immune tolerance to mitochondrial and nuclear antigens, causing injury to the biliary epithelial cells. Fatigue is the commonest reported symptom in PBC and has a negative impact on patients' perceived quality of life, often through social isolation. It is unrelated to the severity of liver disease and appears unresponsive to current therapies, including ursodeoxycholic acid and transplantation. Fatigue in PBC is complex, with numerous associated peripheral and central nervous system (CNS) features. Initially, cholestasis causes degenerative CNS change affecting areas of the brain regulating autonomic dysfunction and sleep, and these changes lead directly to some manifestations of fatigue and the associated cognitive impairment. The aim of the study was to examine global cerebral blood flow with brain perfusion scintigraphy SPECT in well-defined group of PBC Caucasian patients with verbally reported fatigue. Twenty consecutive PBC female patients (median age 58.9, ranges 38-80; 4 cirrhotic) with mean duration of the disease 3.3 years, were prospectively enrolled into the study. Fatigue Impact Scale (FIS) questionnaire was administered to every patients at the moment of brain examination. Brain perfusion scintigraphy SPECT was performed after intravenous injection of 760-800 MBq of technetium99m labeled exametazime (99mTc –HMPAO). Then patients were examined using double head gamma camera system, and data were analyzed with dedicated nuclear medicine software. In analyzed cohort the median FIS score was 70.5 points (ranges 21-160), which was higher than previously reported. There were no correlation between age of patients at the SPECT/FIS examination, duration of the disease, the presence of liver cirrhosis, Mayo Risk Score, and FIS domains: Cognitive, Physical and Social, as well as with brain blood flow. However, positive correlation between Cognitive dimension of FIS measure and right frontal lobe perfusion impairment assessed with SPECT technic (p<0.05) was found. The results of this study showed that right lobe perfusion impairment might impact brain function in PBC. Cognitive dimension was stage-independent symptom in analyzed cohort, and cognitive impairment might be, in turn, associated with functional brain lesion.
VL  - 3
IS  - 4
ER  -

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Author Information

Joanna Raszeja-Wyszomirska

Liver and Internal Medicine Unit, Department of Liver, Transplant and General Surgery of Medical University of Warsaw, Warsaw, Poland
Piotr Zorga

Department of Nuclear Medicine, Pomeranian Medical University, Szczecin, Poland
Marcin Kotulski

Department of Liver, Transplant and General Surgery of Medical University of Warsaw, Warsaw, Poland
Bożena Birkenfeld
Piotr Milkiewicz Milkiewicz

Liver and Internal Medicine Unit, Department of Liver, Transplant and General Surgery of Medical University of Warsaw, Warsaw, Poland

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Joanna Raszeja-Wyszomirska, Piotr Zorga, Marcin Kotulski, Bożena Birkenfeld, Piotr Milkiewicz Milkiewicz. (2017). Brain Perfusion Scintigraphy in Evaluation of Pathogenesis of Fatigue in Patients with Primary Biliary Cholangitis (PBC) – A Pilot Study. International Journal of Clinical and Experimental Medical Sciences, 3(4), 42-46. https://doi.org/10.11648/j.ijcems.20170304.11

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ACS Style

Joanna Raszeja-Wyszomirska; Piotr Zorga; Marcin Kotulski; Bożena Birkenfeld; Piotr Milkiewicz Milkiewicz. Brain Perfusion Scintigraphy in Evaluation of Pathogenesis of Fatigue in Patients with Primary Biliary Cholangitis (PBC) – A Pilot Study. Int. J. Clin. Exp. Med. Sci. 2017, 3(4), 42-46. doi: 10.11648/j.ijcems.20170304.11

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AMA Style

Joanna Raszeja-Wyszomirska, Piotr Zorga, Marcin Kotulski, Bożena Birkenfeld, Piotr Milkiewicz Milkiewicz. Brain Perfusion Scintigraphy in Evaluation of Pathogenesis of Fatigue in Patients with Primary Biliary Cholangitis (PBC) – A Pilot Study. Int J Clin Exp Med Sci. 2017;3(4):42-46. doi: 10.11648/j.ijcems.20170304.11

Copy | Download

@article{10.11648/j.ijcems.20170304.11,
  author = {Joanna Raszeja-Wyszomirska and Piotr Zorga and Marcin Kotulski and Bożena Birkenfeld and Piotr Milkiewicz Milkiewicz},
  title = {Brain Perfusion Scintigraphy in Evaluation of Pathogenesis of Fatigue in Patients with Primary Biliary Cholangitis (PBC) – A Pilot Study},
  journal = {International Journal of Clinical and Experimental Medical Sciences},
  volume = {3},
  number = {4},
  pages = {42-46},
  doi = {10.11648/j.ijcems.20170304.11},
  url = {https://doi.org/10.11648/j.ijcems.20170304.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcems.20170304.11},
  abstract = {Primary biliary cholangitis (PBC) is an autoimmune cholestatic liver disease characterized by a breakdown of immune tolerance to mitochondrial and nuclear antigens, causing injury to the biliary epithelial cells. Fatigue is the commonest reported symptom in PBC and has a negative impact on patients' perceived quality of life, often through social isolation. It is unrelated to the severity of liver disease and appears unresponsive to current therapies, including ursodeoxycholic acid and transplantation. Fatigue in PBC is complex, with numerous associated peripheral and central nervous system (CNS) features. Initially, cholestasis causes degenerative CNS change affecting areas of the brain regulating autonomic dysfunction and sleep, and these changes lead directly to some manifestations of fatigue and the associated cognitive impairment. The aim of the study was to examine global cerebral blood flow with brain perfusion scintigraphy SPECT in well-defined group of PBC Caucasian patients with verbally reported fatigue. Twenty consecutive PBC female patients (median age 58.9, ranges 38-80; 4 cirrhotic) with mean duration of the disease 3.3 years, were prospectively enrolled into the study. Fatigue Impact Scale (FIS) questionnaire was administered to every patients at the moment of brain examination. Brain perfusion scintigraphy SPECT was performed after intravenous injection of 760-800 MBq of technetium99m labeled exametazime (99mTc –HMPAO). Then patients were examined using double head gamma camera system, and data were analyzed with dedicated nuclear medicine software. In analyzed cohort the median FIS score was 70.5 points (ranges 21-160), which was higher than previously reported. There were no correlation between age of patients at the SPECT/FIS examination, duration of the disease, the presence of liver cirrhosis, Mayo Risk Score, and FIS domains: Cognitive, Physical and Social, as well as with brain blood flow. However, positive correlation between Cognitive dimension of FIS measure and right frontal lobe perfusion impairment assessed with SPECT technic (p<0.05) was found. The results of this study showed that right lobe perfusion impairment might impact brain function in PBC. Cognitive dimension was stage-independent symptom in analyzed cohort, and cognitive impairment might be, in turn, associated with functional brain lesion.},
 year = {2017}
}

Copy | Download

TY  - JOUR
T1  - Brain Perfusion Scintigraphy in Evaluation of Pathogenesis of Fatigue in Patients with Primary Biliary Cholangitis (PBC) – A Pilot Study
AU  - Joanna Raszeja-Wyszomirska
AU  - Piotr Zorga
AU  - Marcin Kotulski
AU  - Bożena Birkenfeld
AU  - Piotr Milkiewicz Milkiewicz
Y1  - 2017/09/09
PY  - 2017
N1  - https://doi.org/10.11648/j.ijcems.20170304.11
DO  - 10.11648/j.ijcems.20170304.11
T2  - International Journal of Clinical and Experimental Medical Sciences
JF  - International Journal of Clinical and Experimental Medical Sciences
JO  - International Journal of Clinical and Experimental Medical Sciences
SP  - 42
EP  - 46
PB  - Science Publishing Group
SN  - 2469-8032
UR  - https://doi.org/10.11648/j.ijcems.20170304.11
AB  - Primary biliary cholangitis (PBC) is an autoimmune cholestatic liver disease characterized by a breakdown of immune tolerance to mitochondrial and nuclear antigens, causing injury to the biliary epithelial cells. Fatigue is the commonest reported symptom in PBC and has a negative impact on patients' perceived quality of life, often through social isolation. It is unrelated to the severity of liver disease and appears unresponsive to current therapies, including ursodeoxycholic acid and transplantation. Fatigue in PBC is complex, with numerous associated peripheral and central nervous system (CNS) features. Initially, cholestasis causes degenerative CNS change affecting areas of the brain regulating autonomic dysfunction and sleep, and these changes lead directly to some manifestations of fatigue and the associated cognitive impairment. The aim of the study was to examine global cerebral blood flow with brain perfusion scintigraphy SPECT in well-defined group of PBC Caucasian patients with verbally reported fatigue. Twenty consecutive PBC female patients (median age 58.9, ranges 38-80; 4 cirrhotic) with mean duration of the disease 3.3 years, were prospectively enrolled into the study. Fatigue Impact Scale (FIS) questionnaire was administered to every patients at the moment of brain examination. Brain perfusion scintigraphy SPECT was performed after intravenous injection of 760-800 MBq of technetium99m labeled exametazime (99mTc –HMPAO). Then patients were examined using double head gamma camera system, and data were analyzed with dedicated nuclear medicine software. In analyzed cohort the median FIS score was 70.5 points (ranges 21-160), which was higher than previously reported. There were no correlation between age of patients at the SPECT/FIS examination, duration of the disease, the presence of liver cirrhosis, Mayo Risk Score, and FIS domains: Cognitive, Physical and Social, as well as with brain blood flow. However, positive correlation between Cognitive dimension of FIS measure and right frontal lobe perfusion impairment assessed with SPECT technic (p<0.05) was found. The results of this study showed that right lobe perfusion impairment might impact brain function in PBC. Cognitive dimension was stage-independent symptom in analyzed cohort, and cognitive impairment might be, in turn, associated with functional brain lesion.
VL  - 3
IS  - 4
ER  -

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