Background: Chronic liver disease patients may suffer from a wide spectrum of neuropsychiatric abnormalities that may be associated with cirrhosis and portal hypertension or portal-systemic shunts. Several neuroimaging techniques, especially MR imaging, could be useful for the diagnosis. Also, MRS can identify and measure various chemicals in the brain such as Choline (Cho), Myoinositol (MI), and glutamate-glutamine complex (Glx) that could be induced by liver injury.
Aims: To study the changes in MR brain imaging in CLD and their correlation to manganese and ammonia levels. Methods: The study included 23 patients with CLD and ten healthy control subjects. MR brain was performed on all subjects including T1, T2, and FLAIR sequences, DWI and MRS. Grading of liver disease severity was done. Ammonia and manganese levels were measured in all patients.
Results:
Pallidal T1 Hyperintense signal was recognized in 15 patients. These signals correlated with the manganese levels (P=0.019). Hyperintense WMLs (white matter lesions) in FLAIR sequences were detected in 17 patients. MRS findings in patients with CLD included lower Cho/Cr and MI/Cr and higher Glx/Cr compared to controls (P < 0.05).
Conclusions: MRI and MRS can be used to detect metabolic brain abnormalities in CLD patients and quantify the degree of neurotoxicity. MRI and spectroscopy abnormalities are related to biological abnormalities (Ammonia and Manganese) associated with CLD.