Magnetic resonance imaging and proton spectroscopic alterations correlate with parkinsonian signs in patients with cirrhosis.
OBJECTIVE
The relationship between abnormalities found by magnetic resonance imaging (MRI) and proton spectroscopy (MRS) and the clinical signs of hepatic encephalopathy is not well characterized. Motor disturbances have been described, suggesting that basal ganglia (BG) are altered.


METHODS
We evaluated 19 unselected consecutive patients with biopsy-proven cirrhosis evaluated for liver transplantation for the presence of parkinsonian signs using the Unified Parkinson's Disease Rating Scale (UPDRS) and Purdue Pegboard test, and correlated these neurologic abnormalities with MRI and MRS studies. Brain MRI intensities were expressed as signal-to-noise ratios. MRS findings obtained from one voxel in the BG and one in the occipital white matter (WM) were expressed as metabolite ratios. Six healthy subjects had normal values.


RESULTS
Compared with healthy subjects, patients with subclinical or grade 1 hepatic encephalopathy had hyperintensity in occipital WM and all BG tissues except thalamus and reduced Ino/Cr and Cho/Cr ratios in both voxels. In the BG, MRI intensity was correlated with the UPDRS (P < 0.05, r = 0.56). The Cho/Cr ratio also correlated with both UPDRS (P < 0.02, r = -0.59) and Pegboard scores (P < 0.02, r = 0.61).


CONCLUSIONS
In cirrhosis, parkinsonian signs correlate with BG alterations detected by MRI and MRS.
Spahr
L
L
Division of Gastroenterology and Hepatology, University Hospital, Geneva, Switzerland. Laurent.Spahr@hcuge.ch
Vingerhoets
F
F
Lazeyras
F
F
Delavelle
J
J
DuPasquier
R
R
Giostra
E
E
Mentha
G
G
Terrier
F
F
Hadengue
A
A
D000328:Adult; D001921:Brain / Q000473:pathology; D005260:Female; D006501:Hepatic Encephalopathy / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000503:physiopathology* / Q000523:psychology / Q000601:surgery; D016031:Liver Transplantation; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D020734:Parkinsonian Disorders / Q000503:physiopathology* / Q000523:psychology*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales