High Pallidal T1 Signal is Rarely Observed in Obstructive Jaundice, but is Frequently Observed in Liver Cirrhosis

Bang, Sung-Jo; Choi, Seong Hoon; Park, Neung Hwa; Shin, Jüng Woo; Choy, Nari; Kim, Suk Hwan; Kim, Yangho

doi:10.1539/joh.49.268

Cited by 7 publications

(3 citation statements)

References 26 publications

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“…[5][6][7] Liver cirrhosis prevents Mn clearance via biliary excretion due to a portal systemic shunt, resulting in increased blood Mn and increased signal intensity in GP even in patients not exposed to Mn. 1,2) Our findings, of increased T1 signal intensities in the GP in 61.2% of our patients with hepatitis B-induced liver cirrhosis 12,19,20) and of a significant relationship between PI and blood Mn concentration, [5][6][7]21) were compatible with previous results. Moreover, we found that the severity of liver disease, as assessed by Child-Pugh score, was associated with the prevalence of increased T1 signals in the GP.…”

Section: Discussionsupporting

confidence: 92%

“…Pallidal signals have been reported to be highly prevalent in patients with liver cirrhosis (52-100%). 9,16,19,20) Wide variation in the prevalence of high pallidal signals may be due to differences in the severity of liver diseases of the study subjects. The lower prevalence of high pallidal high signals among our patients than previously reported [19][20][21] may have been due to our inclusion of subjects with less severe liver disease.…”

Section: Discussionmentioning

confidence: 99%

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Pallidal Signal Intensities on T1-weighted MRI are Highly Observed in Advanced Liver Cirrhosis

Weon¹,

Park²,

Kim³

et al. 2012

Korean Journal of Environmental Health Sciences

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Background: Manganese (Mn) has been found to increase the signal intensity of the globus pallidus (GP) on T1-weighted magnetic resonance images (MRI). We performed this study in order to determine the features of liver disease that correlate with pallidal signal intensities. Methods: We assessed blood Mn levels and pallidal signals in T1-weighted MRI in 49 patients with liver cirrhosis and 23 healthy controls. Results: Increased signal intensity in the GP was observed in 30 of 49 (61.2%) patients with liver cirrhosis, with the pallidal index (PI) in patients with Child-Pugh classes B and C differing significantly from the PI in controls. Multiple linear regression analysis showed that blood Mn concentrations and Child-Pugh scores in cirrhotics were significantly associated with increased PI after controlling for other confounders (p<0.05 each). Conclusions: Pallidal signals on T1-weighted MRI are mainly observed in advanced liver cirrhosis. The present study suggests that advanced liver cirrhosis may be a human model for manganism.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Pallidal Signal Intensities on T1-weighted MRI are Highly Observed in Advanced Liver Cirrhosis

Weon¹,

Park²,

Kim³

et al. 2012

Korean Journal of Environmental Health Sciences

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“…This finding has been strongly associated with significant liver disease, but alone is not pathognomonic of portosystemic encephalopathy. [1][2][3] An EEG showed slower theta frequencies, consistent with metabolic encephalopathy (Fig. 2).…”

Section: Radiologic Findingsmentioning

confidence: 94%

A 56-Year-Old Man with Sudden Onset of Portosystemic Encephalopathy Years after Severe Electrocution Trauma

Weiser

Suriawinata²,

Leeuwen³

2008

Semin Liver Dis

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A 56-year-old white male painter, with a history of major electrocution and deep thermal injury, developed mental status changes initially ascribed to an acute neurological event. Unexpectedly, magnetic resonance imaging (MRI) of the head showed areas of high signal intensity in the basal ganglia, which can be observed in advanced liver disease. An electroencephalogram (EEG) suggested metabolic encephalopathy and coexistent elevation of ammonia, indicative of significant liver disease. The patient had had a long history of right upper quadrant pain and fluctuation in liver tests following the electrocution trauma. For these symptoms, he underwent surgery 7 years prior to his current presentation of portosystemic encephalopathy, and was found to have a gangrenous acalculous cholecystitis. Intraoperative cholangiogram suggested possible strictures within the right hepatic ducts. Multiple liver biopsies, however, showed only steatosis. Current evaluation including liver biopsy, MRI, magnetic resonance angiography (MRA), and magnetic resonance cholangiopancreatography (MRCP), revealed progression to biliary cirrhosis with large bile duct obstruction, and hepatic artery thrombosis/occlusion with evidence of left lobe atrophy and right lobe compensatory hypertrophy. The pathobiology of ischemic bile duct injury is discussed herein. The case is an example of serious late sequelae of an occupational injury.

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Acquired hepatocerebral degeneration

2009

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Cirrhosis and its co-morbidities may cause a variety of neurological complications, the most common being bouts of toxic metabolic encephalopathy. A proportion of patients with chronic liver disease develop acquired hepatocerebral degeneration (AHD), a chronic progressive neurological syndrome characterized by parkinsonism, ataxia and other movement disorders. This article reviews the clinical spectrum, pathophysiology, neuroimaging features and differential diagnosis of AHD along with emerging treatment options.

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High Pallidal T1 Signal is Rarely Observed in Obstructive Jaundice, but is Frequently Observed in Liver Cirrhosis

Cited by 7 publications

References 26 publications

Pallidal Signal Intensities on T1-weighted MRI are Highly Observed in Advanced Liver Cirrhosis

Pallidal Signal Intensities on T1-weighted MRI are Highly Observed in Advanced Liver Cirrhosis

A 56-Year-Old Man with Sudden Onset of Portosystemic Encephalopathy Years after Severe Electrocution Trauma

Acquired hepatocerebral degeneration

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