Brain MRI findings in cirrhotic patients: correlation with Doppler US hepatic flow parameters

To determine the relationship of basal ganglia alterations demonstrated on brain MRI and clinical presentation, evaluated with Child-Pugh score, using Color Doppler Ultrasonography parameters of portal hemodynamics in cirrhotic patients with signs of portal hypertension.

Twenty randomly selected cirrhotic patients (16 males and 4 females with a mean age of 63.6+/-8.9 years) classified according to Child-Pugh score (grade A=16 patients, grade B=4), were submitted to Color Doppler US evaluation of hepatic flow and brain MRI. The obtained flow parameters were: PVD, PVCSA, MPVF, MPVFV, HAD, MHAF, hepatic artery RI, CI and MHI. The basal ganglia signal intensity, on T1-weighted images on brain MRI was evaluated both qualitatively (normal, mild, moderate and severe) and quantitatively with the ROI method.

Among Color Doppler parameters, only the CI exhibited a modest correlation with the Child's clinical score (p for linear trend by ANOVA <0.05). Subjective MRI grading demonstrated an excellent correlation with the qualitative assessment of signal density (Spearman p=0.95, p<0.01). When signal intensity on T1-weighted images was analyzed as a continuous variable with normal distribution and ultrasonographic parameters as possible determinants, the portal vein diameter (PVD) and consequently the cross-sectional area (PVCSA) emerged as the sole predictor of MR signal intensity (Pearson's r=0.58, p=0.01).

Although this is a preliminary study and further research should be performed including a larger number of patients, it suggests that Color Doppler US might play a prognostic role in predicting hepatocellular dysfunction and hepatic encephalopathy.