MR Findings of the Brain in Children and Adolescents with Portal Hypertension and the Relationship with Blood Manganese Levels

Pinto, Raquel B.; Fröehlich, Pedro Eduardo; Pitrez, Eduardo Hennemann; Becker, J. Sabine; Cornely, A.; Schneider, Ana Cláudia Reis; Silveira, Themis Reverbel da

doi:10.1055/s-0030-1254157

Cited by 5 publications

(4 citation statements)

References 20 publications

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“…Characteristic MRI observations associated with chronic HE include cerebral atrophy and bilateral symmetric hyperintensities of the globus pallidus (GP) on T1-weighted images without corresponding signal intensities in T2-weighted images [ 7 ]. This signal hyperintensity is thought to be due to the deposition of manganese associated with the portosystemic shunt and decreased hepatobiliary clearance of metabolites from the intestines [ 8 ]. An accumulation of manganese will contribute to the dysfunction of neurons and astrocytes leading to HE [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Development of a New Index to Distinguish Hepatic Encephalopathy through Automated Quantification of Globus Pallidal Signal Intensity Using MRI

et al. 2022

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Hyperintensities within the bilateral globus pallidus on T1-weighted magnetic resonance images were present in some liver cirrhosis patients with hepatic encephalopathy. The symptoms of covert hepatic encephalopathy are similar to those of mild dementia. We aimed to develop a new diagnostic index in which to distinguish hepatic encephalopathy from dementia. The globus pallidus signal hyperintensity was quantified using three-dimensional images. In addition, the new index value distribution was evaluated in a cohort of dementia patients. Signal intensity of globus pallidus significantly increased in liver cirrhosis patients with hepatic encephalopathy compared to those without hepatic encephalopathy (p < 0.05), healthy subjects (p < 0.05) or dementia patients (p < 0.001). Only 12.5% of liver cirrhosis patients without hepatic encephalopathy and 2% of dementia patients exceeded the new index cut-off value of 0.994, which predicts hepatic encephalopathy. One dementia patient in our evaluation had a history of liver cancer treatment and was assumed to have concomitant hepatic encephalopathy. The automatic assessment of signal intensity in globus pallidus is useful for distinguishing liver cirrhosis patients with hepatic encephalopathy from healthy subjects and liver cirrhosis patients without hepatic encephalopathy. Our image analyses exclude possible cases of hepatic encephalopathy from patients with neurocognitive impairment, including dementia.

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Section: Introductionmentioning

confidence: 99%

“…The signal intensity of GP is detected by subjectively selecting regions of interest chosen by the operator [ 7 , 8 , 11 , 12 , 13 ]; therefore, there is a possibility of discrepancies between operators. Therefore, computer automation is desirable insofar as it allows for objectivity in judgment.…”

Section: Introductionmentioning

confidence: 99%

Development of a New Index to Distinguish Hepatic Encephalopathy through Automated Quantification of Globus Pallidal Signal Intensity Using MRI

et al. 2022

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“…In patients with cirrhosis, pallidal T1 hyperintensity is a well‐known finding related to manganese (Mn) deposition in the brain from an increased Mn blood concentration, secondary to portal shunting and failure of hepatobiliary clearance of metabolites from the intestines 5 . Manganese accumulation, along with other neurotoxins, contributes to neurotransmitter dysregulation and neuron and astrocyte dysfunction that culminates in hepatic encephalopathy 6,7 .…”

Section: Introductionmentioning

confidence: 99%

“…Manganese accumulation, along with other neurotoxins, contributes to neurotransmitter dysregulation and neuron and astrocyte dysfunction that culminates in hepatic encephalopathy 6,7 . Previous studies evaluating T1 SI related to Mn deposition in the basal ganglia of patients with cirrhosis have traditionally relied on manually drawn regions of interest (ROI) and the use of ratios where the SI of targeted area is compared to that of background tissue 5,8–10 . However, using white matter (WM) and brainstem regions as uninvolved reference regions is problematic since pathology studies demonstrate diffuse Mn deposition throughout the brain, including in these regions 11 .…”

Section: Introductionmentioning

confidence: 99%

MRI Automated T1 Signal Intensity Detection of Diffuse Brain Manganese Accumulation in Cirrhosis

Wei

Tran

Chang

et al. 2020

Journal of Neuroimaging

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BACKGROUND AND PURPOSE Cirrhosis is associated with diffuse brain manganese deposition, which results in increased signal intensity (SI) in the brain on T1‐weighted images, most often visualized in the globus pallidus. The purpose of this study was to determine if automated image intensity measurements can detect SI differences in the basal ganglia and other regions reported to have manganese deposition in patients with cirrhosis compared with controls. METHODS T1 FSPGR images were acquired on 28 patients with cirrhosis and 28 age‐sex‐matched controls. FreeSurfer T1 SI values were obtained for the globus pallidus, putamen, cerebral white matter, cerebral cortex, and brainstem. SI ratios were computed for globus pallidus normalized to white matter and brainstem. SI values and SI ratios were compared between groups using t‐tests. RESULTS Among people with cirrhosis, T1 SI was significantly increased in the globus pallidus, putamen, cerebral white matter, cerebral cortex, and brainstem (P< .001), and the globus pallidus to brainstem ratio was significantly increased (P< .001). No significant difference was seen for globus pallidus to cerebral white matter T1 SI ratio (P = .38). CONCLUSIONS Automatic assessment of T1 SI allows for rapid, objective identification of widespread T1 shortening associated with manganese deposition in cirrhosis, consistent with the global deposition of neurotoxic manganese seen in pathology studies. This automated T1 assessment may have broader utility for other conditions beyond cirrhosis impacting T1 SI.

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Manganese and the Brain

Tuschl¹,

Mills²,

Clayton³

2013

International Review of Neurobiology

182

119

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MR Findings of the Brain in Children and Adolescents with Portal Hypertension and the Relationship with Blood Manganese Levels

Cited by 5 publications

References 20 publications

Development of a New Index to Distinguish Hepatic Encephalopathy through Automated Quantification of Globus Pallidal Signal Intensity Using MRI

Development of a New Index to Distinguish Hepatic Encephalopathy through Automated Quantification of Globus Pallidal Signal Intensity Using MRI

MRI Automated T1 Signal Intensity Detection of Diffuse Brain Manganese Accumulation in Cirrhosis

Manganese and the Brain

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