Gray matter microstructural alterations and their correlation with systemic biomarkers in hepatic encephalopathy: a NODDI study using gray-matter based spatial statistics

NODDI reveals extensive microstructural alterations consistent with reduced neurite density index and cerebellar disorganization in HE. The dissociated correlation patterns of GP NDI and ODI with distinct blood markers may be compatible with a hypothetical "double-hit" pathophysiological model: toxic metabolite accumulation may drive cellular swelling (increased NDI), while systemic factors like anemia may reduce structural complexity (decreased ODI). However, these exploratory associations do not allow causal inference. These findings highlight NODDI could be a useful tool for monitoring the progression and metabolic impact of HE.