Primary biliary cholangitis patients exhibit MRI changes in structure and function of interoceptive brain regions.

BACKGROUND: Many patients with primary biliary cholangitis (PBC) experience non-hepatic symptoms that are possibly linked to altered interoception, the sense of the body's internal state. We used magnetic resonance imaging (MRI) to determine if PBC patients exhibit structural and functional changes of the thalamus and insula, brain regions that process signals related to interoception. METHODS: Fifteen PBC patients with mild disease and 17 controls underwent 3 Tesla T1-weighted MRI, resting-state functional MRI, and quantitative susceptibility mapping (QSM), to measure thalamic and insular volume, neuronal activity and iron deposition, respectively. Group differences were assessed using analysis of covariance, and stepwise linear regression was used to determine the predictive power of clinical indicators of disease. RESULTS: PBC patients exhibited reduced thalamic volume (p < 0.01), and ursodeoxycholic acid (UDCA) non-responders exhibited lower left thalamus activity (p = 0.05). PBC patients also exhibited reduced anterior insula activity (p = 0.012), and liver stiffness positively correlated with MRI indicators of anterior insula iron deposition (p < 0.02). CONCLUSIONS: PBC affects structure and function of brain regions critically important to interoception. Moreover, these brain changes occur in patients with early, milder disease and thus may potentially be reversible.

Frontal lobe epilepsy alters functional connections within the brain's motor network: a resting-state fMRI study.

Patients with frontal lobe epilepsy (FLE) often experience motor deficits, yet little is known of the impact of FLE on the activity of motor networks in the brain. Resting-state functional magnetic resonance imaging (rs-fMRI) has previously demonstrated an association between cognitive deficits in temporal lobe epilepsy patients and disruption of activity within pertinent brain networks. Hence, in the present study, rs-fMRI was used to determine whether FLE is associated with motor network disruption. Seven right-hemisphere FLE patients, six left-hemisphere FLE patients, and nine control subjects underwent rs-fMRI. Functional connectivity was computed between the sensorimotor cortex contralateral to the seizure focus and each voxel in the brain, and then compared voxel-by-voxel between patient groups and controls. A laterality index (LI) of connectivity between contralateral and ipsilateral sensorimotor cortices was calculated to investigate its association with epilepsy duration and seizure frequency. Positive laterality indices indicate reduced connectivity, and zero values indicate strong connectivity. Connectivity between the left and right sensorimotor cortices was significantly reduced in FLE patients compared with controls (p<0.05), and LI was positively correlated with the number of lifetime seizures (left FLE: rs=0.89, right FLE: rs=1.00). Patients with FLE exhibit decreased connectivity within the motor network, in correlation with the number of lifetime seizures, thus demonstrating a potential relationship between seizure activity and changes in motor network organization. These findings suggest that motor network disturbances may in part be responsible for the motor deficits observed in FLE patients.