NEUROSPECTROSCOPIC ALTERATIONS AND GLOBUS-PALLIDUS HYPERINTENSITY AS RELATED MAGNETIC-RESONANCE MARKERS OF REVERSIBLE HEPATIC-ENCEPHALOPATHY

In patients with chronic hepatic encephalopathy, proton magnetic reson ance spectroscopy can be used to detect specific metabolic abnormaliti es in the brain; MRI shows a hyperintense globus pallidus on T-1-weigh ted sequences. We investigated the relationship between these two MR f indings in a series of 25 patients with the use of quantitative data a nd a multiple regression analysis model. The cerebral increase in glut amine compounds and the decrease in myoinositol and choline correlated separately with globus pallidus hyperintensity, and each was compleme ntary in accounting for this imaging finding. Such an association sugg ests that spectroscopic and imaging alterations are two different-expr essions of the reversible events that occur in the brain of patients w ith hepatic encephalopathy in that both disappear after liver transpla ntation. Globus pallidus hyperintensity seems to be a global indicator of the cerebral metabolic disorder, and the spectroscopic pattern den otes the specific metabolic alterations.