MRI And ～1H-MRS Study On Basal Ganglia Alterations In Patients With Liver Cirrhosis

Objective The purpose of this study was to study the relationship between the clinical signs, cognitive impairment, extrapyramidal impairment and the signal changes, metabolic alterations in the basal ganglia (BG) by using MRI, proton magnetic resonance spectroscopy (~1H-MRS) and a neuropsychological test battery in patients with hepatic cirrhosis. Methods MRI and ' H-MRS in the basal ganglia in 27 patients (22 males, 5 females, the age ranged from 29 to 62 years, mean age 43 years) with definite liver cirrhosis were studied, in which including 8 Child class A patients and 19 Child class B-C patients, 16 patients were classified as having subclinical hepatic encephalopathy (SHE), 14 patients were classified as having parkinsonian signs. 18 age-matched healthy volunteers (13 males, 5 females, the age ranged from 24 to 51 years, mean age 38 years) underwent MRI and ~1H-MRS for comparison. Brain MRI intensities were expressed as signal intensity ratios, MRS findings obtained from one voxel in the BG were expressed as metabolite ratios. The same neuropsychological tests were carried in all patients and healthy volunteers. Results NAA/Cr levels showed no statistical difference among all the patients with cirrhosis and the control group (P>0.05). Values of signal hyperintensities in globus pallidus and ratios of ml/Cr and Cho/Cr showed no differences between the control group and the patients of Child class A, the patients without SHE and the patients without parkinsonism (P>0.05), whereas they were significantly different between the patients of Child class A and B-C, without and with SHE, without and with parkinsonism (P<0.01). In patients with cirrhosis, the values of signal hyperintensities in globus pallidus were inversely correlated with ml/Cr (r=-0.764, P<0.05) and Cho/Cr (r=-0.553, P<0.05), respectively. Conclusion Signal hyperintensities in globus pallidus and...