Published ahead of print on June 26, 2008
doi: 10.3174/ajnr.A1139
MR Imaging Findings in Hepatic Encephalopathy
A. Roviraa,
J. Alonsoa,b and
J. Córdobab,c,d
a Magnetic Resonance Unit (Institut de Diagnostic per La Imatge), Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
b Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
c Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Barcelona, Spain
d Department of Medicine, Autonomous University of Barcelona, Cerdanyola del Vallès, Spain
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Fig 1. Transverse T1-weighted MR images of the brain in a patient with chronic liver failure and parkinsonism. Observe the bilateral and symmetric high T1 signal-intensity change involving the globus pallidus and the anterior midbrain.
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Fig 2. 1H-MR-spectroscopy water-suppressed proton spectra of an 8-mL voxel located in the parietal region including predominantly normal-appearing white matter in a patient with cirrhosis before (left) and after (right) liver transplantation, recorded with a stimulated echo acquisition mode pulse sequence (TR/TE, 1600/20 ms; acquisitions, 256). The main resonances correspond to N-acetylaspartate (NAA, 2.0 ppm), glutamine/glutamate (Glx, 2.1–2.5 ppm), creatine/phosphocreatine (Cr, 3.02 ppm), choline-containing compounds (Cho, 3.2 ppm), and myo-inositol (Ins, 3.55 ppm). The initial spectrum shows an increase in the glutamate/glutamine region and a decrease in the myo-inositol and choline resonances. These abnormalities normalized after liver transplantation. Normal NAA indices are seen in both examinations.
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Fig 3. A, Transverse T2-weighted fast FLAIR images obtained in a patient with liver cirrhosis during an episode of hepatic encephalopathy. Observe the symmetric areas of increased signal intensity along the corticospinal tract in both cerebral hemispheres. B, This signal-intensity abnormality almost completely reverses on a follow-up study obtained few months later, when the patient showed no signs of overt hepatic encephalopathy.
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Fig 4. A, Baseline MR imaging study (transverse fast FLAIR T2-weighted image) of a 56-year-old patient with hepatitis C cirrhosis without overt hepatic encephalopathy. Multiple focal WMLs in both cerebral hemispheres are attributed to small-vessel disease. B, A new scan obtained 2 years later during an episode of hepatic encephalopathy shows marked increase in the size of these focal WMLs. C, A new follow-up scan after complete resolution of neurologic symptoms shows a decrease in the size of the WMLs. This last scan was almost identical to the first study. A lacunar infarct is seen in the deep right frontal white matter.
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