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AJNR - American Journal of Neuroradiology

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Magnetization Transfer Ratio Values and Proton MR Spectroscopy of Normal-appearing Cerebral White Matter in Patients with Liver Cirrhosis

Alex Rovira^a, Elisenda Grivé^a, Salvador Pedraza^a, Antoni Rovira^a and Juli Alonso^a

^a From the Magnetic Resonance Unit, Department of Radiology, Vall d'Hebron Teaching Hospitals, Barcelona, Spain.

View larger version (83K): [in a new window]   FIG 1. Transverse T1-weighted image (inversion recovery spin-echo; 1500/20; inversion time, 650 ms; number of acquisitions, one), obtained at the level of the basal ganglia in a patient with liver cirrhosis, shows bilateral increased signal in the globus pallidus. For calculating the globus pallidus index, mean signal intensity was calculated from a region of interest localized in both the putamen () and globus pallidus ().FIG 2. Transverse MTR map of a supraventricular level, obtained from two proton density gradient-echo sequences (714/12; flip angle, 20 degrees; number of acquisitions, one), the first with and the second without an off-resonance preparation pulse. MTR values were obtained from four different voxels () located in otherwise normal-appearing white matter, as defined on the T2-weighted sequence, within both parietal and frontal lobes.FIG 3. Axial T2-weighted image (fast spin-echo; 3550/90; number of acquisitions, two), obtained at a supraventricular level, shows the voxel from which the 1H-MRS image was obtained in the normal appearing white matter in the parietal lobe

View larger version (21K): [in a new window]   FIG 4. Water-suppressed proton spectra of an 8-mL voxel located in the parietal region, recorded with a stimulated echo-based pulse sequence (1600/20; magnetization transfer, 30; number of acquisitions, 256). The main resonances correspond to N-acetylaspartate (2.0 ppm), glutamic/glutamine (2.1-2.5 ppm), creatine/phosphocreatine (3.02 ppm), choline-containing compounds (3.2 ppm), and myo-inositol (3.55 ppm). Comparison of the spectra shows a decrease in choline and myo-inositol resonances, with an increase in the glutamic/glutamine region in the cirrhotic patient. A, Healthy control volunteer. B, Cirrhotic patient.