Cerebral edema, a well-known feature of acute liver disease, can occur in 
cirrhotic patients regardless of hepatic encephalopathy (HE) and adversely 
affect prognosis. This study characterized and correlated functional HE 
abnormalities in the brain to cerebral edema using resting-state functional 
magnetic resonance imaging (rs-fMRI) and diffusion tensor imaging (DTI). 
Forty-one cirrhotic patients (16 without HE, 14 minimal HE, 11 overt HE) and 32 
healthy controls were assessed. The HE grade in cirrhotic patients was evaluated 
by the West Haven criteria and neuro-psychological examinations. Functional 
connectivity correlation coefficient (fc-CC) of the default mode network (DMN) 
was determined by rs-fMRI, while the corresponding mean diffusivity (MD) was 
obtained from DTI. Correlations among inter-cortical fc-CC, DTI indices, 
Cognitive Ability Screening Instrument scores, and laboratory tests were also 
analyzed. Results showed that gradual reductions of HE-related consciousness 
levels, from "without HE" or "minimal HE" to "overt HE", correlated with 
decreased anterior-posterior fc-CC in DMN [F(4.415), p = 0.000)]. The MD values 
from regions with anterior-posterior fc-CC differences in DMN revealed 
significant differences between the overt HE group and other groups. Increased 
MD in this network was inversely associated with decreased fc-CC in DMN and 
linearly correlated with poor cognitive performance. In conclusion, cerebral 
edema can be linked to altered cerebral temporal architecture that modifies both 
within- and between-network connectivity in HE. Reduced fc-CC in DMN is 
associated with behavior and consciousness deterioration. Through appropriate 
targets, rs-fMRI technology may provide relevant supplemental information for 
monitoring HE and serve as a new biomarker for clinical diagnosis.