Investigative Magnetic Resonance Imaging

Korean Society of Magnetic Resonance in Medicine (대한자기공명의과학회)
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The Pallidal Index in Patients with Acute-on-Chronic Liver Disease: Is It a Predictor of Severe Hepatic Encephalopathy?

  • Lee, Dong Hyun (Department of Radiology, Kyungpook National University Hospital) ;
  • Lee, Hui Joong (Department of Radiology, Kyungpook National University Hospital) ;
  • Hahm, Myong Hun (Department of Radiology, Kyungpook National University Hospital)
  • Received : 2017.08.02
  • Accepted : 2017.09.20
  • Published : 2017.09.30
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Abstract

Purpose: To evaluate the clinical significance of T1 high signal intensity on the globus pallidus as a predictor of severe hepatic encephalopathy in patients with acute-on-chronic liver failure (ACLF), which is a distinct syndrome characterized by multi-organ dysfunction including cerebral failure. Materials and Methods: From January 2002 to April 2014, we retrospectively reviewed the magnetic resonance imaging (MRI) findings and clinical and magnetic resonance (MR) features of 74 consecutive patients (44 men and 30 women; mean age, 59.5 years) with liver cirrhosis. The chronic liver failure-sequential organ failure assessment score was used to diagnose ACLF. The pallidal index (PI), calculated by dividing the mean signal intensity of the globus pallidus by that of the subcortical frontal white matter were compared according to ACLF. The PI was compared with the Model for End-Stage Liver Disease (MELD) score in predicting the development of ACLF. Results: Fifteen patients who were diagnosed with ACLF had higher hepatic encephalopathy grades (initial, P = 0.024; follow-up, P = 0.002), MELD scores (P < 0.001), and PI (P = 0.048). In the ACLF group, the mean PI in patients with cerebral failure was significantly higher than that in the patients without cerebral failure (1.33 vs. 1.20, P = 0.039). In patients with ACLF, the area under the curve (AUC) for PI was 0.680 (95% confidence intervals [CI], 0.52-0.85), which was significantly lower than that for the MELD score (AUC, 0.88; 95% CI, 0.77-0.99) (P = 0.04). Conclusion: The PI can be an ancillary biomarker for predicting the development of ACLF and severe hepatic encephalopathy.

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References

  1. Sherlock S. Hepatic encephalopathy. Br J Hosp Med 1977;17:144-146, 151-144, 159
  2. Romero-Gomez M, Montagnese S, Jalan R. Hepatic encephalopathy in patients with acute decompensation of cirrhosis and acute-on-chronic liver failure. J Hepatol 2015;62:437-447 https://doi.org/10.1016/j.jhep.2014.09.005
  3. Wright G, Sharifi Y, Jover-Cobos M, Jalan R. The brain in acute on chronic liver failure. Metab Brain Dis 2014;29:965-973 https://doi.org/10.1007/s11011-014-9553-0
  4. Inoue E, Hori S, Narumi Y, et al. Portal-systemic encephalopathy: presence of basal ganglia lesions with high signal intensity on MR images. Radiology 1991;179:551-555 https://doi.org/10.1148/radiology.179.2.2014310
  5. Pujol A, Pujol J, Graus F, et al. Hyperintense globus pallidus on T1-weighted MRI in cirrhotic patients is associated with severity of liver failure. Neurology 1993;43:65-69 https://doi.org/10.1212/WNL.43.1_Part_1.65
  6. Zeneroli ML, Cioni G, Crisi G, Vezzelli C, Ventura E. Globus pallidus alterations and brain atrophy in liver cirrhosis patients with encephalopathy: an MR imaging study. Magn Reson Imaging 1991;9:295-302 https://doi.org/10.1016/0730-725X(91)90414-H
  7. Burkhard PR, Delavelle J, Du Pasquier R, Spahr L. Chronic parkinsonism associated with cirrhosis: a distinct subset of acquired hepatocerebral degeneration. Arch Neurol 2003;60:521-528 https://doi.org/10.1001/archneur.60.4.521
  8. Li SJ, Jiang L, Fu X, et al. Pallidal index as biomarker of manganese brain accumulation and associated with manganese levels in blood: a meta-analysis. PLoS One 2014;9:e93900 https://doi.org/10.1371/journal.pone.0093900
  9. Chang Y, Woo ST, Kim Y, et al. Pallidal index measured with three-dimensional T1-weighted gradient echo sequence is a good predictor of manganese exposure in welders. J Magn Reson Imaging 2010;31:1020-1026 https://doi.org/10.1002/jmri.22104
  10. Rovira A, Alonso J, Cordoba J. MR imaging findings in hepatic encephalopathy. AJNR Am J Neuroradiol 2008;29:1612-1621 https://doi.org/10.3174/ajnr.A1139
  11. Volk ML, Marrero JA. Advances in critical care hepatology. Minerva Anestesiol 2006;72:269-281
  12. Delis SG, Bakoyiannis A, Biliatis I, Athanassiou K, Tassopoulos N, Dervenis C. Model for end-stage liver disease (MELD) score, as a prognostic factor for postoperative morbidity and mortality in cirrhotic patients, undergoing hepatectomy for hepatocellular carcinoma. HPB (Oxford) 2009;11:351-357 https://doi.org/10.1111/j.1477-2574.2009.00067.x
  13. Moreau R, Jalan R, Gines P, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology 2013;144:1426-1437, 1437 e1421-1429 https://doi.org/10.1053/j.gastro.2013.02.042
  14. Blei AT, Cordoba J, Practice Parameters Committee of the American College of Gastroenterology. Hepatic encephalopathy. Am J Gastroenterol 2001;96:1968-1976 https://doi.org/10.1111/j.1572-0241.2001.03964.x
  15. Currier DP. Elements of research in physical therapy. Baltimore: Lippincott Williams and Wilkins, 1990
  16. Krieger D, Krieger S, Jansen O, Gass P, Theilmann L, Lichtnecker H. Manganese and chronic hepatic encephalopathy. Lancet 1995;346:270-274 https://doi.org/10.1016/S0140-6736(95)92164-8
  17. Spahr L, Butterworth RF, Fontaine S, et al. Increased blood manganese in cirrhotic patients: relationship to pallidal magnetic resonance signal hyperintensity and neurological symptoms. Hepatology 1996;24:1116-1120 https://doi.org/10.1002/hep.510240523
  18. Sarin SK, Kumar A, Almeida JA, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the study of the liver (APASL). Hepatol Int 2009;3:269-282 https://doi.org/10.1007/s12072-008-9106-x
  19. Shin YC, Kim E, Cheong HK, et al. High signal intensity on magnetic resonance imaging as a predictor of neurobehavioral performance of workers exposed to manganese. Neurotoxicology 2007;28:257-262 https://doi.org/10.1016/j.neuro.2006.03.014
  20. Arroyo V, Moreau R, Jalan R, Gines P, EASL-CLIF Consotrium CANONIC Study. Acute-on-chronic liver failure: A new syndrome that will re-classify cirrhosis. J Hepatol 2015;62:S131-143 https://doi.org/10.1016/j.jhep.2014.11.045
  21. Hoofnagle JH, Carithers RL Jr, Shapiro C, Ascher N. Fulminant hepatic failure: summary of a workshop. Hepatology 1995;21:240-252
  22. Herrero Hernandez E, Valentini MC, Discalzi G. T1-weighted hyperintensity in basal ganglia at brain magnetic resonance imaging: are different pathologies sharing a common mechanism? Neurotoxicology 2002;23:669-674 https://doi.org/10.1016/S0161-813X(02)00016-5
  23. Criswell SR, Perlmutter JS, Huang JL, et al. Basal ganglia intensity indices and diffusion weighted imaging in manganese-exposed welders. Occup Environ Med 2012;69:437-443 https://doi.org/10.1136/oemed-2011-100119