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Encéphalopathie hépatique chez les patiens atteints de cirrhose : le TIPS comme facteur de risque, apport de l'IRM multitmodale

Marika Rudler 1
1 Inserm UMR_S 938 - Pathologies biliaires, fibrose et cancer du foie
CR Saint-Antoine - Centre de Recherche Saint-Antoine, CHU Saint-Antoine [AP-HP]
Abstract : TIPS placement is required for the management of variceal bleeding or ascites in cirrhosis. However, hepatic encephalopathy (HE) may occur in 35% of patients after TIPS placement. Magnetic resonance imaging (MRI) is the best exam for the diagnosis and the prognosis of several neurological diseases. Multimodal MRI combines spectroscopy, diffusion tensor imaging and resting state. It has been proven to help for neurological prognostic in comatose patients after traumatic brain injury or cardiac arrest. In this manuscript, we will explain HE pathophysiology and management of HE in 2017. We will also describe results obtained with TIPS placement in patients with variceal bleeding. The second part of the manuscript will be dedicated to multimodal MRI: we will clarify each technique and what has been published in the setting of cirrhosis. Last, we will explain our results obtained in patients who are candidate for non urgent TIPS placement and will suggest that a low fractional anisotropy before TIPS may help to identify patients that are at risk of developing HE after TIPS.
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Marika Rudler. Encéphalopathie hépatique chez les patiens atteints de cirrhose : le TIPS comme facteur de risque, apport de l'IRM multitmodale. Physiologie [q-bio.TO]. Université Pierre et Marie Curie - Paris VI, 2017. Français. ⟨NNT : 2017PA066532⟩. ⟨tel-01953460⟩

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