Publication Name	World Journal of Radiology
Manuscript ID	119600
Country	Chile

Category	Radiology, Nuclear Medicine & Medical Imaging
Manuscript Type	Correspondence
Article Title	Letter to the Editor: Beyond the liver - integrating emerging predictors in hepatic encephalopathy after transjugular intrahepatic portosystemic shunt
Manuscript Source	Invited Manuscript
All Author List	Cristian Lindner, Andrés Concha and David Clemo
Funding Agency and Grant Number
Corresponding Author	Cristian Lindner, MD, Department of Radiology, Faculty of Medicine, University of Concepción, San Martín 1436, Concepción 4030000, Chile. clindner146@gmail.com
Key Words	Hepatic encephalopathy; Transjugular intrahepatic portosystemic shunt; Cerebral blood flow; Sarcopenia; Portal hypertension
Core Tip	While Zhuang et al identify cerebral hypoperfusion as a hallmark of post-transjugular intrahepatic portosystemic shunt encephalopathy, this letter argues that these changes represent the final downstream consequence of a systemic multi-hit failure. We integrate emerging evidence on the gut-liver-muscle axis, emphasizing that sarcopenia, the AMMON-OHE model, and shunt magnitude are critical upstream determinants of neurotoxicity. We propose that to prevent cognitive decline, specialists must move beyond isolated hemodynamic targets and adopt a precision medicine approach, tailoring stent expansion to the patient's individual metabolic and muscular reserve.
Citation	Lindner C, Concha A, Clemo D. Letter to the Editor: Beyond the liver - integrating emerging predictors in hepatic encephalopathy after transjugular intrahepatic portosystemic shunt. World J Radiol 2026; In press

Received	2026-02-02 00:51
Peer-Review Started	2026-02-02 00:52
First Decision by Editorial Office Director	2026-02-12 08:25
Return for Revision	2026-02-12 08:25
Revised	2026-02-20 00:33
Publication Fee Transferred
Second Decision by Editor	2026-03-24 02:48
Second Decision by Editor-in-Chief
Final Decision by Editorial Office Director	2026-03-24 07:50
Articles in Press	2026-03-24 07:50
Edit the Manuscript by Language Editor
Typeset the Manuscript

ISSN	1949-8470 (online)
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