Bright basal ganglia in T1-weighted magnetic resonance images are frequent in patients with portal vein thrombosis without liver cirrhosis and not suggestive of hepatic encephalopathy

doi:10.1016/S0168-8278(98)80063-9

Journal of Hepatology

Volume 29, Issue 3, September 1998, Pages 443-449

https://doi.org/10.1016/S0168-8278(98)80063-9 Get rights and content

Abstract

Background/Aims: Deposition of paramagnetic substances in basal ganglia, resulting in increased signals in T1-weighted magnetic resonance images (bright basal ganglia), is frequently seen in liver cirhrosis. The present study describes the prevalence of bright basal ganglia and its clinical significance in patients with long-standing portal vein thrombosis in the absence of liver cirrhosis.

Methods: Six patients with angiographically proven complete portal vein thrombosis and cavernomatous transformation without signs of acute or chronic liver disease were studied by magnetic resonance imaging of the brain, neuropsychiatric evaluation, psychometric tests, electroencephalography, and determination of arterial ammonia levels and of serum manganese concentrations from peripheral venous blood.

Results: Five out of six patients demonstrated increased signal intensity in the basal ganglia. Overt portal-systemic encephalopathy was not noted prior to or at the time of evaluation. Normal EEG results were recorded in all patients. Only one of the six patients had pathological results in at least two out of four psychometric tests. This latter patient had had a large right-sided brain infarction. Arterial ammonia concentrations were normal in four of the six patients; one patient with increased ammonia levels had concomitant renal insufficiency with azotemia. The other four patients had no relevant concomitant diseases. Serum manganese levels were non-significantly increased compared with control group (p=0.06), but they were significantly correlated to basal ganglia signal intensity (R=0.88; p=0.02).

Conclusions: Our results demonstrate that bright basal ganglia primarily represent shunt-induced alterations. They are not directly associated with disturbed liver function nor with portal-systemic encephalopathy.

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One study could not find a statistically significant correlation between globus pallidus signals in T1W images with chronic HE.28 Another study demonstrated that basal ganglia hyperintensity represents shunt-induced alterations including portal vein thrombosis and cavernous transformation without signs of liver disease, rather than altered liver function or HE.29 Fukuzawa and colleagues30 showed that pallidal hyperintensity on MRI was more prominent in patients with idiopathic portal hypertension than in those with liver cirrhosis, and there was no correlation between hyperintensity and severity of liver dysfunction or HE; there was a stronger correlation with portosystemic shunt in portal hypertension than liver cirrhosis.
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Bright basal ganglia in T1-weighted magnetic resonance images are frequent in patients with portal vein thrombosis without liver cirrhosis and not suggestive of hepatic encephalopathy

Abstract

Clin Imaging

Hepatology

Hepatology

J Hepatol

Gastroenterology

Lancet

Exp Neurol

Gastroenterology

Lancet

J Hepatol

Lancet

Chronic acquired hepatic failure: MR imaging of the brain at 1.5 T

Am J Neuroradiol

Hyperintensity in the globus pallidus on T1-weighted and inversion-recovery MRI: a possible marker of advanced liver disease

Neurology

Pallidal hyperintensity on magnetic resonance imaging in cirrhotic patients: clinical correlations

Hepatology

Hyperintense globus pallidus on T1-weighted MRI in cirrhotic patients is associated with severity of liver failure

Neurology

Portal-systemic encephalopathy: presence of basal ganglia lesions with high signal intensity on MR images

Radiology

Manganese in health and disease

Physiol Rev

Manganese intoxication and chronic liver failure

Ann Neurol

Manganese and chronic hepatic encephalopathy

Lancet

Accumulation of copper and manganese in brain of cirrhotic patients: role in the pathogenesis of hepatic encephalopathy (HE)

J Hepatol

Increased manganese (Mn2+) in blood and in palladium of cirrhotic patients with hepatic encephalopathy: factor responsible for magnetic resonance (MR) signal hyperintensity

Gastroenterology

Hyperintensity in the globus pallidus on T₁-weighted and inversion-recovery MRI: a possible marker of advanced liver disease

Hyperintense globus pallidus on T₁-weighted MRI in cirrhotic patients is associated with severity of liver failure

Increased manganese (Mn²⁺) in blood and in palladium of cirrhotic patients with hepatic encephalopathy: factor responsible for magnetic resonance (MR) signal hyperintensity