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Globus pallidus MR signal abnormalities in children with chronic liver disease and/or porto-systemic shunting

  • Paediatric
  • Published:
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Abstract

Objectives

Detection of subclinical hepatic encephalopathy in children is difficult. We aimed to assess the changes in imaging of the central nervous system in children with chronic liver disease using MR imaging, diffusion, and 1H -spectroscopy.

Methods

Forty three children with chronic liver disease and/or porto-systemic shunting (111.4±56.9 months) and 24 controls (72.0±51.8 months) underwent brain MRI/spectroscopy on a 1.5T to examine T1, T2, ADC, Cho/Cr, ml/Cr, Glx/Cr ratio spectroscopy in the globus pallidus. Patients were divided into 3 groups according to the ratios of globus pallidus/putamen T1 signal : isointense (i), hyperintense (h), much more hyperintense (h+). The relationship with clinical and biological data was analyzed.

Results

T1 signal intensity and ml/Cr were significantly different between controls and group h+ (p=0.001). ADC did not differ significantly between groups. Age correlated strongly with the presence of a T1 signal ratio (p > 0.001). There was no correlation between imaging findings and biological parameters.

Conclusions

In children with chronic liver disease and/or porto-systemic shunting, the presence of a hyperintense T1 signal in the globus pallidus correlated strongly with age. Biological and clinical parameters were not predictive of these changes. MRI may become a useful screening tool for hepatic encephalopathy in children.

Key Points

• Children with chronic liver disease should undergo brain MRI during their follow-up

• T1 hyperintensity of globus pallidus is suggestive of liver-related CNS involvement

• MRS mI/Cr is decreased in children with chronic liver disease

• Biological parameters (ammonium) were not predictive of hepatic encephalopathy

• Duration of chronic liver disease may be causative the hepatic encephalopathy

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Abbreviations

CLD:

Chronic liver disease

mHE:

Minimal hepatic encephalopathy

HE:

Hepatic encephalopathy

PSS:

Porto-systemic shunting

GP:

Globus pallidus

ROI:

Region-of-interest

mI:

myoInositol

Gln:

Glutamine

Cho:

Choline

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Author information

Authors and Affiliations

  1. Department of Pediatric Radiology, University Hospital of Geneva, Geneva, Switzerland

    Sylviane Hanquinet, Mehrak Anooshiravani & Laura Merlini

  2. Swiss Center for Liver Disease in Children, University Hospital of Geneva, Geneva, Switzerland

    Claire Morice, Vladimir Cousin & Valérie A. McLin

  3. Division of Quality of Care, University Hospital of Geneva, Geneva, Switzerland

    Delphine S. Courvoisier

Authors
  1. Sylviane Hanquinet
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  2. Claire Morice
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  3. Delphine S. Courvoisier
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  4. Vladimir Cousin
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  5. Mehrak Anooshiravani
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  6. Laura Merlini
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  7. Valérie A. McLin
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Correspondence to Sylviane Hanquinet.

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Guarantor

The scientific guarantor of this publication is Sylviane Hanquinet.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Funding

The authors state that this work has not received any funding.

Statistics and biometry

One of the authors has significant statistical expertise.

Ethical approval

Institutional Review Board approval was obtained.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Methodology

• retrospective

• diagnostic or prognostic study

• performed at one institution

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Cite this article

Hanquinet, S., Morice, C., Courvoisier, D.S. et al. Globus pallidus MR signal abnormalities in children with chronic liver disease and/or porto-systemic shunting. Eur Radiol 27, 4064–4071 (2017). https://doi.org/10.1007/s00330-017-4808-x

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  • DOI: https://doi.org/10.1007/s00330-017-4808-x

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