title: Globus pallidus MR signal abnormalities in children with chronic liver disease and/or porto-systemic shunting.
abstract: OBJECTIVE
  Detection of subclinical hepatic encephalopathy in children is difficult. We aimed to assess the changes in imaging of the central nervous system in children with chronic liver disease using MR imaging, diffusion, and1H -spectroscopy.
  
  
  METHODS
  Forty three children with chronic liver disease and/or porto-systemic shunting (111.4±56.9 months) and 24 controls (72.0±51.8 months) underwent brain MRI/spectroscopy on a 1.5T to examine T1, T2, ADC, Cho/Cr, ml/Cr, Glx/Cr ratio spectroscopy in the globus pallidus. Patients were divided into 3 groups according to the ratios of globus pallidus/putamen T1 signal : isointense (i), hyperintense (h), much more hyperintense (h+). The relationship with clinical and biological data was analyzed.
  
  
  RESULTS
  T1 signal intensity and ml/Cr were significantly different between controls and group h+ (p=0.001). ADC did not differ significantly between groups. Age correlated strongly with the presence of a T1 signal ratio (p > 0.001). There was no correlation between imaging findings and biological parameters.
  
  
  CONCLUSIONS
  In children with chronic liver disease and/or porto-systemic shunting, the presence of a hyperintense T1 signal in the globus pallidus correlated strongly with age. Biological and clinical parameters were not predictive of these changes. MRI may become a useful screening tool for hepatic encephalopathy in children.
  
  
  CONCLUSIONS
  • Children with chronic liver disease should undergo brain MRI during their follow-up • T1 hyperintensity of globus pallidus is suggestive of liver-related CNS involvement • MRS mI/Cr is decreased in children with chronic liver disease • Biological parameters (ammonium) were not predictive of hepatic encephalopathy • Duration of chronic liver disease may be causative the hepatic encephalopathy.
authors.affiliation: Department of Pediatric Radiology, University Hospital of Geneva, Geneva, Switzerland. sylviane.hanquinet-ginter@hcuge.ch.
authors.forename: Sylviane
authors.initials: S
authors.lastname: Hanquinet
authors.affiliation: Swiss Center for Liver Disease in Children, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Claire
authors.initials: C
authors.lastname: Morice
authors.affiliation: Division of Quality of Care, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Delphine S
authors.initials: DS
authors.lastname: Courvoisier
authors.affiliation: Swiss Center for Liver Disease in Children, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Cousin
authors.affiliation: Department of Pediatric Radiology, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Mehrak
authors.initials: M
authors.lastname: Anooshiravani
authors.affiliation: Department of Pediatric Radiology, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Laura
authors.initials: L
authors.lastname: Merlini
authors.affiliation: Swiss Center for Liver Disease in Children, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Valérie A
authors.initials: VA
authors.lastname: McLin
mesh_terms: D000293:Adolescent; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D056324:Diffusion Tensor Imaging; D005260:Female; D005917:Globus Pallidus / Q000000981:diagnostic imaging* / Q000473:pathology; D006501:Hepatic Encephalopathy / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D007223:Infant; D008107:Liver Diseases / Q000150:complications; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male
keywords: Child; Chronic liver disease; Hepatic encephalopathy; Portosystemic shunting; T1 hyperintense