MR Findings of the Brain in Children and Adolescents with Portal Hypertension and the Relationship with Blood Manganese Levels

Abstract

Background: Few studies have evaluated abnormalities on brain magnetic resonance imaging (MRI) in children and adolescents with chronic liver disease.

Aims: The aim of this study was to investigate the presence of T1 hyperintensity in the basal ganglia of pediatric patients with portal hypertension and its association with blood manganese levels.

Methods: A case control study of 22 patients with portal hypertension (14 Child-Pugh A cirrhosis, 8 non-cirrhotic portal hypertension) and 15 controls was conducted from 2006 to 2007. Blood manganese levels were measured using atomic absorption spectrophotometry. Brain MRI scans were performed using a 1.5 Tesla (Philips) scanner.

Results: Blood manganese levels were 26.01±12.82 μg/L for patients with portal hypertension (cirrhotic: 22.73±11.67 μg/L, non-cirrhotic: 32±13.32 μg/L) and 15.64±6.61 μg/L for controls (p=0.003). 14/22 patients with portal hypertension presented T1 hyperintensity in the basal ganglia [6/14 cirrhotic; 8/8 non-cirrhotic (p=0.018); zero controls (p=0.001)]. Mean blood manganese levels of patients with liver disease and normal vs. abnormal brain MRI scans were 18.45±8.38 μg/L and 30.47±13.07 μg/L, respectively (p=0.04).

Conclusions: Brain MRI showed a high frequency (64%) of T1 hyperintensity in the basal ganglia of patients with portal hypertension, which correlated positively with blood manganese levels. This abnormality was found in 100% of the patients with portal hypertension and in 43% of those with mild cirrhotic disease.

Key words

liver disease - brain magnetic resonance imaging - children - manganese - atomic absorption spectrophotometry

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