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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Correspondence
Themis Reverbel daSilveira
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