Krieger S, Jauss M, Jansen O, Theilmann L, Geissler M, Krieger D
Department of Gastroenterology, Ruprecht-Karls University, Heidelberg, Germany.
Gastroenterology. 1996 Jul;111(1):147-55. doi: 10.1053/gast.1996.v111.pm8698193.
BACKGROUND & AIMS: Hyperintense globus pallidus on T1-weighted magnetic resonance images (MRIs) in cirrhotic patients are reported to reflect severity of liver disease; however, their consequence for hepatic encephalopathy is unknown. The aim of this study was to outline a pattern of neuropsychiatric abnormalities in chronic liver failure and its correlation with MRI findings.
Fifty-one consecutive patients were enrolled in the study. Neuropsychiatric assessment used a standardized protocol, including dichotomized neurological parameters, brief psychiatric rating and psychometric tests, as well as electroencephalography. The severity of liver failure was graded using standard laboratory parameters and the Child-Pugh's classification. Signal intensity of the globus pallidus was determined on sagittal T1-weighted MRIs.
Two aspects of neurological dysfunction could be distinguished by principal components analysis: impairment of complex cerebral function and subcortical motor performance. Both neurological categories correlated with severity of liver failure, grade of electroencephalographic abnormalities, and psychometric test results. Additionally, prior bouts of overt encephalopathy indicate progressive dementia. T1-weighted globus pallidus signal intensity did not correlate with any clinical or laboratory test result.
This study shows a characteristic pattern of neurological findings in patients with liver failure and hyperintense globus pallidus on T1-weighted MRIs. Although neurological dysfunction parallels hepatic failure, MRI abnormalities of basal ganglia do not indicate severity of actual hepatic encephalopathy.
据报道，肝硬化患者在T1加权磁共振成像（MRI）上苍白球高信号反映了肝脏疾病的严重程度；然而，其与肝性脑病的关系尚不清楚。本研究的目的是概述慢性肝衰竭患者神经精神异常的模式及其与MRI表现的相关性。
连续纳入51例患者。神经精神评估采用标准化方案，包括二分法神经学参数、简短精神科评定和心理测量测试，以及脑电图检查。使用标准实验室参数和Child-Pugh分类法对肝衰竭的严重程度进行分级。在矢状面T1加权MRI上测定苍白球的信号强度。
通过主成分分析可区分神经功能障碍的两个方面：复杂脑功能损害和皮质下运动表现。这两个神经学类别均与肝衰竭的严重程度、脑电图异常分级和心理测量测试结果相关。此外，既往明显的脑病发作提示进行性痴呆。T1加权苍白球信号强度与任何临床或实验室检查结果均无相关性。
本研究显示了肝衰竭患者以及T1加权MRI上苍白球高信号患者的神经学表现特征模式。尽管神经功能障碍与肝衰竭平行，但基底节的MRI异常并不表明实际肝性脑病的严重程度。
