Deep gray matter iron measurement in patients with liver cirrhosis using quantitative susceptibility mapping: Relationship with pallidal T1 hyperintensity

Abstract

Background: The liver is a central organ for the metabolism of iron and manganese and the places where those metals are commonly deposited overlap in the brain.

Purpose/hypothesis: To elucidate the relationship between pallidal T₁ hyperintensity and iron deposition in the deep gray matter of liver cirrhosis patients using quantitative susceptibility mapping (QSM).

Study type: Retrospective case-control study SUBJECTS: In all, 38 consecutive liver cirrhosis patients who received brain magnetic resonance imaging (MRI) as pretransplant evaluation.

Field strength/sequence: QSM was reconstructed from 3D multi- or single-echo phase images at 3T. T₁ -weighted images were used for the assessment of pallidal hyperintensity and pallidal index (PI).

Assessment: Patients were divided into two groups according to the presence of pallidal hyperintensity by consensus of two radiologists. Susceptibility values were acquired for five deep gray matter structures.

Statistical test: QSM measures were compared between two groups using the t-test. We also calculated Pearson correlations between QSM measures and PI.

Results: In all, 26 patients showed pallidal hyperintensity (T₁ h group) and 12 did not (T₁ n group). The susceptibility of the globus pallidus (GP) in the T₁ h group (120.6 ± 38.1 ppb) was significantly lower than that in the T₁ n group (150.0 ± 35.2, P = 0.030). The susceptibility of the dentate nucleus (DN) in the T₁ h group (88.1 ± 31.0) was significantly lower than that in the T₁ n group (125.6 ± 30.6, P = 0.001). Negative correlation between the susceptibility of GP (r = -0.37, P = 0.022) and the PI, and between DN (r = -0.43, P < 0.001) and the PI was found.

Data conclusion: Liver cirrhosis patients with pallidal T₁ hyperintensity had lower susceptibility values in the GP and DN than those without it. This suggests a possible interaction between iron and manganese in the brains of liver cirrhosis patients.

Level of evidence: 3 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:1342-1349.

Keywords: Quantitative susceptibility mapping; deep gray matter; iron; liver cirrhosis; manganese; pallidal hyperintensity.