AUTHOR=Zhang Yunli , Huang Zhai , Qin Bin , Tang Shiting , Huang Peng , Tang Xiaogang , Lin Xuezhen , Liu Yayuan , Deng Xuhui , Zhu Feiqi , Xing Shihui , Liang Zhijian 

TITLE=PerAF-based resting-state fMRI classifier for minimal hepatic encephalopathy

JOURNAL=Frontiers in Neurology

VOLUME=Volume 16 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2025.1603396

DOI=10.3389/fneur.2025.1603396

ISSN=1664-2295

ABSTRACT=BackgroundMinimal hepatic encephalopathy (MHE) is a common cognitive impairment in patients with end-stage liver cirrhosis. However, the selection of sensitive biomarkers and the establishment of reliable diagnostic methods are currently challenging. We aimed to explore the abnormal spontaneous brain activity in patients with MHE and evaluate the clinical diagnostic value of four indicators for MHE using the support vector machine (SVM) method.MethodsA total of 45 MHE patients and 40 healthy controls were enrolled. Amplitude of low frequency fluctuation (ALFF), fractional amplitude of low frequency fluctuation (fALFF), percentage amplitude of low frequency fluctuation (PerAF), and regional homogeneity (ReHo) were used to evaluate local spontaneous brain activity. SVM analysis was used to construct the classification model and evaluate the diagnostic value.ResultsTwo-sample t-test and SVM analysis showed that, compared with the healthy control group, MHE patients had decreased ALFF values in the left angular gyrus, right inferior temporal gyrus, left postcentral gyrus, precentral gyrus, and right supplementary motor area. These regions indicated moderate classification efficacy (AUC = 0.75). Decreased ReHo metrics in the right anterior cingulate and paracingulate gyri also showed general discriminative power (AUC = 0.72). fALFF metrics, whether analyzed independently or combined with other indicators, exhibited limited classification performance (AUC < 0.70). Decreased PerAF metrics in the right superior parietal lobule, right dorsolateral prefrontal cortex, and right middle frontal gyrus achieved a good classification accuracy rate (AUC value 0.83; accuracy 81.18%; sensitivity 75.56%; specificity 87.50%), outperforming other functional metrics.ConclusionWe found that decreased mean PerAF in the right supramarginal gyrus, right dorsolateral superior frontal gyrus, and right middle frontal gyrus may serve as potential neuroimaging indicators for early identification of cognitive impairment in MHE patients, providing critical evidence for clinical screening protocols.