Hyperintense globus pallidus on T ₁ ‐weighted MRI in cirrhotic patients is associated with severity of liver failure

Abstract

Hyperintense globus pallidus on T1-weighted MRI is present in most patients with advanced liver disease. We evaluated the relationship between the signal intensity of the globus pallidus and clinical or laboratory data of 77 patients eligible for liver transplantation. There was a significant correlation between the intensity of the signal and the Child-Pugh score (as indication of severity of liver disease), presence of postural tremor, previous episodes of variceal bleeding or hepatic encephalopathy, prothrombin activity, serum aspartate and alanine aminotransferase, bilirubin, and the indocyanine green (ICG) hepatic clearance, a very sensitive marker of liver function. The multivariate analysis disclosed that the ICG hepatic clearance and previous episodes of variceal bleeding were independently associated with the signal intensity in the globus pallidus. MRI repeated in 21 patients 10 to 20 months after transplant showed a disappearance of the lesion in all cases. We conclude that the hyperintense globus pallidus is secondary to the severity of the liver disease, and is reversible when liver function returns to normal.

Manganese deposition in basal ganglia structures results from both portal-systemic shunting and liver dysfunction

“…1 Increasing evidence suggests that accumulation of manganese could best explain this finding. Pallidal samples obtained at autopsy from cirrhotic patients who died in hepatic encephalopathy contain up to 7-fold increased manganese content.…”

“…5, 6, 7, 8 and 9 These inconsistencies could result from the large variability in patient population as well as the different methods of evaluation of neuropsychological status. The aims of the present series of experiments were (1) to measure the regional selectivity of manganese accumulation in the brains of cirrhotic patients compared with appropriate material from matched-controls; and (2) to determine the relative influence of portal-systemic shunting and cholestasis (both factors being suggested as major determinants for brain manganese deposition) on manganese accumulation in the brains of rats with chronic liver failure.…”

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“…Typical pallidal images were also described in a patient with patent ductus venosus (spontaneous portocaval shunt) in the absence of liver disease (Yanai et al, 1995) and in 6 patients with portal vein thrombosis, portal-systemic collaterals and a normal liver (Nolte et al, 1998). On the other hand, the important pathogenetic role of liver failure is illustrated by the disappearance of pallidal hyperintensity several months after liver transplantation (Pujol et al, 1993). More recently, brain manganese accumulation was observed in a rat model of cholestatic cirrhosis as well as in rats with end-to-side portacaval shunt but with a normal liver (Rose et al, 1997).…”

“…Pallidal signal hyperintensity on magnetic resonance imaging (MRI) has been observed in a majority of cirrhotic patients (Figure 1; Krieger et al, 1996;Pujol et al, 1993;Spahr et al, 1996). Such images could theoretically be caused by lipid deposition, calcification, melanin, methemoglobin or manganese.…”

Brain MRI, Tc-99m HMPAO SPECT and F-18 FP-CIT PET/CT Findings in a Patient with Wilson Disease: A Case Report

“…The degree of signal change on MRI increases with disease severity [6], and signal abnormality regresses following decoppering drug therapy [7].…”