Magnetic resonance images of the globus pallidus in patients with idiopathic portal hypertension: A quantitative analysis of the relationship between signal intensity and the grade of portosystemic shunt

Fukuzawa, Takeshi; Matsutani, Shoichi; Maruyama, Hitoshi; Akiike, Taro; Saisho, Hiromitsu; Hattori, Takamichi

doi:10.1111/j.1440-1746.2006.04226.x

Cited by 21 publications

(13 citation statements)

References 35 publications

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“…Finally, although detection of other portosystemic collaterals besides EV improves the specificity of NH4, it is barely important in clinical practice as prophylactic remedies are not warranted. On the contrary, our figures are corroborated by previous data speculating on hyperintense globus pallidus on T1-weighted cranial magnetic resonance imaging [45]. …”

Section: Discussionsupporting

confidence: 91%

Blood ammonia levels in liver cirrhosis: a clue for the presence of portosystemic collateral veins

et al. 2009

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BackgroundPortal hypertension leads to the formation of portosystemic collateral veins in liver cirrhosis. The resulting shunting is responsible for the development of portosystemic encephalopathy. Although ammonia plays a certain role in determining portosystemic encephalopathy, the venous ammonia level has not been found to correlate with the presence or severity of this entity. So, it has become partially obsolete. Realizing the need for non-invasive markers mirroring the presence of esophageal varices in order to reduce the number of endoscopy screening, we came back to determine whether there was a correlation between blood ammonia concentrations and the detection of portosystemic collateral veins, also evaluating splenomegaly, hypersplenism (thrombocytopenia) and the severity of liver cirrhosis.MethodsOne hundred and fifty three consecutive patients with hepatic cirrhosis of various etiologies were recruited to participate in endoscopic and ultrasonography screening for the presence of portosystemic collaterals mostly esophageal varices, but also portal hypertensive gastropathy and large spontaneous shunts.ResultsBased on Child-Pugh classification, the median level of blood ammonia was 45 mcM/L in 64 patients belonging to class A, 66 mcM/L in 66 patients of class B and 108 mcM/L in 23 patients of class C respectively (p < 0.001).The grade of esophageal varices was concordant with venous ammonia levels (rho 0.43, p < 0.001). The best area under the curve was given by ammonia concentrations, i, e., 0.78, when comparing areas of ammonia levels, platelet count and spleen longitudinal diameter at ultrasonography. Ammonia levels predicted hepatic decompensation and ascites presence (Odds Ratio 1.018, p < 0.001).ConclusionIdentifying cirrhotic patients with high blood ammonia concentrations could be clinically useful, as high levels would lead to suspicion of being in presence of collaterals, in clinical practice of esophageal varices, and pinpoint those patients requiring closer follow-up and endoscopic screening.

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Section: Discussionsupporting

confidence: 91%

Blood ammonia levels in liver cirrhosis: a clue for the presence of portosystemic collateral veins

et al. 2009

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“…Animal models of portal-systemic shunt without cirrhosis have higher concentrations of Mn in the basal ganglia than in animal models of cirrhosis 24) . Moreover, high pallidal T1 signals were more prominent in patients with idiopathic portal hypertension than in patients with liver cirrhosis 25) , showing that there is no correlation between pallidal T1 hyperintensity and the severity of liver dysfunction or hepatic encephalopathy. Taken together, these findings suggest that portal-systemic shunt per se may be a major determinant in the etiology of pallidal T1 signals.…”

Section: Discussionmentioning

confidence: 92%

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

Bang

Choi

Park

et al. 2007

Journal of Occupational Health

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“…First, we did not measure the level of manganese in the blood, although correlations between the biochemical alterations and blood manganese have been consistently reported in patients with liver dysfunction [47], [48]. To comprehensively understand the influences of manganese dysmetabolism on brain dysfunction, additional correlation analyses between the level of blood manganese and resting-state functional connectivity may be necessary in further studies.…”

Section: Discussionmentioning

confidence: 99%

Aberrant Resting-State Corticostriatal Functional Connectivity in Cirrhotic Patients with Hyperintense Globus Pallidus on T1-Weighted MR Imaging

et al. 2012

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Neurobiological and neuroimaging studies have emphasized the structural and functional alterations in the striatum of cirrhotic patients, but alterations in the functional connections between the striatum and other brain regions have not yet been explored. Of note, manganese accumulation in the nervous system, frequently reflected by hyperintensity at the bilateral globus pallidus (GP) on T1-weighted imaging, has been considered a factor affecting the striatal and cortical functions in hepatic decompensation. We employed resting-state functional magnetic resonance imaging to analyze the temporal correlation between the striatum and the remaining brain regions using seed-based correlation analyses. The two-sample t-test was conducted to detect the differences in corticostriatal connectivity between 44 cirrhotic patients with hyperintensity at the bilateral GP and 20 healthy controls. Decreased connectivity of the caudate was detected in the anterior/middle cingulate gyrus, and increased connectivity of the caudate was found in the left motor cortex. A reduction in functional connectivity was found between the putamen and several regions, including the anterior cingulate gyrus, right insular lobe, inferior frontal gyrus, left parahippocampal gyrus, and anterior lobe of the right cerebellum; increased connectivity was detected between the putamen and right middle temporal gyrus. There were significant correlations between the corticostriatal connectivity and neuropsychological performances in the patient group, but not between the striatal connectivity and GP signal intensity. These alterations in the corticostriatal functional connectivity suggested the abnormalities in the intrinsic brain functional organiztion among the cirrhotic patients with manganese deposition, and may be associated with development of metabolic encephalopathy. The manganese deposition in nervous system, however, can not be an independent factor predicting the resting-state brain dysfunction in real time.

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Magnetic resonance images of the globus pallidus in patients with idiopathic portal hypertension: A quantitative analysis of the relationship between signal intensity and the grade of portosystemic shunt

Abstract: Hyperintensity of the globus pallidus on T1-weighted MRI correlated with the development of PSS independent of liver cell function. This brain image should be an index of the grade of PSS rather than a landmark of chronic liver failure.

Cited by 21 publications

References 35 publications

Blood ammonia levels in liver cirrhosis: a clue for the presence of portosystemic collateral veins

Blood ammonia levels in liver cirrhosis: a clue for the presence of portosystemic collateral veins

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

Aberrant Resting-State Corticostriatal Functional Connectivity in Cirrhotic Patients with Hyperintense Globus Pallidus on T1-Weighted MR Imaging

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