Brain MR imaging in patients with hepatic cirrhosis: relationship between high intensity signal in basal ganglia on T1-weighted images and elemental concentrations in brain |
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Authors: | H Maeda M Sato A Yoshikawa M Kimura T Sonomura M Terada K Kishi |
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Institution: | (1) Department of Radiology, Wakayama Medical College, 27-7, Wakayama City, 640, Japan, JP |
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Abstract: | In patients with hepatic cirrhosis, the globus pallidus and putamen show high intensity on T1-weighted MRI. While the causes
of this high signal have been thought to include paramagnetic substances, especially manganese, no evidence for this has been
presented. Autopsy in four cases of hepatic cirrhosis permitted measurement of metal concentrations in brain and histopathological
examination. In three cases the globus pallidus showed high intensity on T1-weighted images. Mean manganese concentrations
in globus pallidus, putamen and frontal white matter were 3.03 ± 0.38, 2.12 ± 0.37, and 1.38 ± 0.24 (μg/g wet weight), respectively,
being approximately four- to almost ten-fold the normal values. Copper concentrations in globus pallidus and putamen were
also high, 50 % more than normal. Calcium, iron, zinc and magnesium concentrations were all normal. The fourth case showed
no abnormal intensity in the basal ganglia and brain metal concentrations were all normal. Histopathologically, cases with
showing high signal remarkable atrophy, necrosis, and deciduation of nerve cells and proliferation of glial cells and microglia
in globus pallidus. These findings were similar to those in chronic manganese poisoning. On T1-weighted images, copper deposition
shows no abnormal intensity. It is therefore inferred that deposition of highly concentrations of manganese may caused high
signal on T1-weighted images and nerve cell death in the globus pallidus.
Received: 12 August 1996 Accepted: 17 December 1996 |
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Keywords: | Brain magnetic resonance imaging Basal ganglia Cirrhosis hepatic Manganese |
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