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Classic MR imaging abnormalities include high signal intensity in the globus palidum on T1-weighted images, likely a reflection of increased tissue concentrations of manganese, and an elevated glutamine/glutamate peak coupled with decreased myo-inositol and choline signals on proton MR spectroscopy, representing disturbances in cell-volume homeostasis secondary to brain hyperammonemia. Recent data have shown that white matter abnormalities, also related to increased CNS ammonia concentration, can also be detected with several MR imaging techniques such as magnetization transfer ratio measurements, fast fluid-attenuated inversion recovery sequences, and diffusion weighted images. All these MR imaging abnormalities, which return to normal with restoration of liver function, probably reflect the presence of mild diffuse brain edema, which seems to play an essential role in the pathogenesis of HE. It is likely that MR imaging will be increasingly used to evaluate the mechanisms involved in the pathogenesis of HE and to assess the effects of therapeutic measures focused on correcting brain edema in these patients. |
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alcohol,neurologic complications with
alcoholism
ammonia
cerebral edema
globus pallidus,lesion of
globus pallidus,lesion of,bilateral
hepatic encephalopathy
hepatic failure
liver disease
MRI
MRI,abnormal
MRI,diffusion weighted
MRI,disappearing lesion on
pyramidal tract
reversible neurologic disorder
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