title: Magnetic resonance imaging of brain in patients with cirrhotic and non-cirrhotic portal hypertension.
abstract: BACKGROUND
  Hyperintense signals in the basal ganglia, namely the globus pallidus, have been reported on magnetic resonance imaging (MRI) in 70-100% of patients with cirrhosis of the liver. Deposition of paramagnetic substances, particularly manganese (Mn), has been reported to be responsible for these hyperintense signals. They are found in cirrhotics with or without overt/subclinical hepatic encephalopathy. Deposition of Mn has been attributed to hepatocellular failure and/or portosystemic shunting. Reports of MRI brain findings in patients with extra hepatic portal venous obstruction (EHPVO) and non-cirrhotic portal fibrosis (NCPF) are scanty in the literature.
  
  
  OBJECTIVE
  The purpose was to determine the basal ganglia changes on MRI in patients with EHPVO and NCPF and to compare it with patients with cirrhosis of the liver.
  
  
  METHODS
  A total of 27 patients (EHPVO = 10, mean age 28.4 +/- 19.0 years, NCPF = 7, mean age 37.1 +/- 10.4 years, cirrhosis = 10, mean age 47.0 +/- 19.6 years) was studied prospectively from January to December 2001. MRI of the brain was done with a standard spin echo axial T1- and fast spin echo T2-weighted scan obtained on a 1.5-T MRI unit. Two radiologists in a blinded fashion graded the signal intensity of basal ganglia on T1-weighted (T1 W) sequences by comparing it with the adjacent unaffected grey matter.
  
  
  RESULTS
  None of the patients with EHPVO or NCPF had any past history of hepatic decompensation and/or overt encephalopathy. Seven (70%) of the cirrhotics had a past history of overt encephalopathy. None of the patients with EHPVO showed any hyperintensity of basal ganglia on T1-weighted MRI images. Hyperintense globus pallidus was seen in four (57%) and eight (80%) patients with NCPF and cirrhosis, respectively.
  
  
  CONCLUSIONS
  Hyperintense globus pallidus on MRI is common in patients liver cirrhosis and also occurs in patients with NCPF. Patients with EHPVO do not have hyperintense globus pallidus on T1-weighted MRI images.
authors.affiliation: Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Kshaunish
authors.initials: K
authors.lastname: Das
authors.forename: Paramjeet
authors.initials: P
authors.lastname: Singh
authors.forename: Yogesh
authors.initials: Y
authors.lastname: Chawla
authors.forename: Ajay
authors.initials: A
authors.lastname: Duseja
authors.forename: Radha Krishan
authors.initials: RK
authors.lastname: Dhiman
authors.forename: Sudha
authors.initials: S
authors.lastname: Suri
mesh_terms: D000293:Adolescent; D000328:Adult; D001479:Basal Ganglia / Q000473:pathology; D001921:Brain / Q000473:pathology*; D005260:Female; D005917:Globus Pallidus / Q000473:pathology*; D006501:Hepatic Encephalopathy / Q000473:pathology; D006801:Humans; D006975:Hypertension, Portal / Q000473:pathology*; D008103:Liver Cirrhosis / Q000473:pathology*; D008105:Liver Cirrhosis, Biliary / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008345:Manganese / Q000493:pharmacokinetics; D008875:Middle Aged
chemical_list: D008345:Manganese