Cerebral magnetic resonance imaging of liver cirrhosis patients

Thirty-two patients with liver cirrhosis underwent cerebral magnetic resonance imaging (MRI) to evaluate clinical and subclinical portal-systemic encephalopathy (PSE). Symmetrically hyperintense globus pallidi were observed on T1-weighted images in all 11 patients with PSE and in 15 of the 21 patients with PSE. This abnormality was classified as grade I (bilateral globus pallidi with mild to moderate hyperintensity relative to white matter), and grade II (marked hyperintensity bilaterally in the globus pallidi with mildly increased signal intensities in the surrounding structures). Portal-systemic collateral vessels were demonstrated in 23 of 24 patients who underwent abdominal angiography. In 18 of the 19 patients with abnormal MRI, collateral vessels were supplied by the superior mesenteric vein with or without the splenic vein, including four patients with collaterals which were less than 10 mm in diameter. We concluded that hyperintense globus pallidi on T1-weighted images are significant manifestations of clinical PSE. When portal-systemic collaterals supplied by the superior mesenteric vein are observed, even if they are of small diameter, cerebral MRI should be performed to evaluate for subclinical PSE.