MRI FINDINGS IN CHRONIC HEPATIC-ENCEPHALOPATHY DEPEND ON PORTOSYSTEMIC SHUNT - RESULTS OF A CONTROLLED PROSPECTIVE CLINICAL INVESTIGATION

Background/Aims: Deterioration of hepatic encephalopathy is a major co ncern with the transjugular intrahepatic portosystemic shunt procedure , Symmetric hyperintense globus pallidus on T1-weighted cranial magnet ic resonance imaging in patients with liver cirrhosis anticipates hepa tocerebral disease, It is hypothesized that hepatic encephalopathy and basal ganglia signal intensity progress in patients with cirrhosis of the liver undergoing transjugular intrahepatic portosystemic shunt, M ethods: Twenty-four patients were randomized to undergo either transju gular intrahepatic portosystemic shunt or elective sclerotherapy, At s tudy entry and 6 months after randomization, neurologic assessment, ps ychometric tests, standard EEG, and magnetic resonance imaging were pe rformed, The severity of liver failure was graded using Child-Pugh's c lassification, The signal intensity of the globus pallidus was determi ned on sagittal T1-weighted magnetic resonance imaging, Results: The T 1-weighted signal intensity of the globus pallidus on magnetic resonan ce imaging significantly increased after transjugular intrahepatic por tosystemic shunt placement (p<0,01), but not with elective sclerothera py At follow-up, neurological symptoms indicating decline of mental st atus and motor performance were somewhat more prevalent in transjugula r intrahepatic portosystemic shunt patients, Significant deterioration of EEG abnormalities occurred in patients treated with transjugular i ntrahepatic portosystemic shunt as opposed to elective sclerotherapy ( p<0,01), Conclusions: Transjugular intrahepatic portosystemic shunt pr ocedure increases hyperresonant globus pallidus on magnetic resonance imaging, Neuropsychiatric evaluation shows advancing hepatic encephalo pathy, in particular with transjugular intrahepatic portosystemic shun t; however, it does not parallel the augmentation of pallidal signal i ntensity on magnetic resonance imaging.