Maeda H, Sato M, Yoshikawa A, Kimura M, Sonomura T, Terada M, Kishi K
Department of Radiology, Wakayama Medical College, Japan.
Neuroradiology. 1997 Aug;39(8):546-50. doi: 10.1007/s002340050464.
In patients with hepatic cirrhosis, the globus pallidus and putamen show high intensity on T1-weighted MRI. While the causes of this high signal have been thought to include paramagnetic substances, especially manganese, no evidence for this has been presented. Autopsy in four cases of hepatic cirrhosis permitted measurement of metal concentrations in brain and histopathological examination. In three cases the globus pallidus showed high intensity on T1-weighted images. Mean manganese concentrations in globus pallidus, putamen and frontal white matter were 3.03 +/- 0.38, 2.12 +/- 0.37, and 1.38 +/- 0.24 (micrograms/g wet weight), respectively, being approximately four- to almost ten-fold the normal values. Copper concentrations in globus pallidus and putamen were also high, 50% more than normal. Calcium, iron, zinc and magnesium concentrations were all normal. The fourth case showed no abnormal intensity in the basal ganglia and brain metal concentrations were all normal. Histopathologically, cases with showing high signal remarkable atrophy, necrosis, and deciduation of nerve cells and proliferation of glial cells and microglia in globus pallidus.. These findings were similar to those in chronic manganese poisoning. On T1-weighted images, copper deposition shows no abnormal intensity. It is therefore inferred that deposition of highly concentrations of manganese may caused high signal on T1-weighted images and nerve cell death in the globus pallidus.
在肝硬化患者中，苍白球和壳核在T1加权磁共振成像（MRI）上显示高强度信号。虽然这种高信号的原因被认为包括顺磁性物质，尤其是锰，但尚未有相关证据。对4例肝硬化患者进行尸检，以测量脑内金属浓度并进行组织病理学检查。3例患者的苍白球在T1加权图像上显示高强度信号。苍白球、壳核和额叶白质中的平均锰浓度分别为3.03±0.38、2.12±0.37和1.38±0.24（微克/克湿重），约为正常值的4至近10倍。苍白球和壳核中的铜浓度也很高，比正常水平高50%。钙、铁、锌和镁的浓度均正常。第4例患者基底神经节未显示异常信号，脑内金属浓度均正常。组织病理学上，显示高信号的病例在苍白球有明显的萎缩、坏死、神经细胞脱失以及胶质细胞和小胶质细胞增生。这些发现与慢性锰中毒的情况相似。在T1加权图像上，铜沉积未显示异常信号。因此推断，高浓度锰的沉积可能导致T1加权图像上出现高信号以及苍白球神经细胞死亡。
