Investig Magn Reson Imaging.  2017 Sep;21(3):125-130. 10.13104/imri.2017.21.3.125.

The Pallidal Index in Patients with Acute-on-Chronic Liver Disease: Is It a Predictor of Severe Hepatic Encephalopathy?

• Lee DH
• Lee HJ
• Hahm MH

• KMID: 2392682
• DOI: http://doi.org/10.13104/imri.2017.21.3.125

Abstract

PURPOSE
To evaluate the clinical significance of T1 high signal intensity on the globus pallidus as a predictor of severe hepatic encephalopathy in patients with acute-on-chronic liver failure (ACLF), which is a distinct syndrome characterized by multi-organ dysfunction including cerebral failure.
MATERIALS AND METHODS
From January 2002 to April 2014, we retrospectively reviewed the magnetic resonance imaging (MRI) findings and clinical and magnetic resonance (MR) features of 74 consecutive patients (44 men and 30 women; mean age, 59.5 years) with liver cirrhosis. The chronic liver failure-sequential organ failure assessment score was used to diagnose ACLF. The pallidal index (PI), calculated by dividing the mean signal intensity of the globus pallidus by that of the subcortical frontal white matter were compared according to ACLF. The PI was compared with the Model for End-Stage Liver Disease (MELD) score in predicting the development of ACLF.
RESULTS
Fifteen patients who were diagnosed with ACLF had higher hepatic encephalopathy grades (initial, P = 0.024; follow-up, P = 0.002), MELD scores (P < 0.001), and PI (P = 0.048). In the ACLF group, the mean PI in patients with cerebral failure was significantly higher than that in the patients without cerebral failure (1.33 vs. 1.20, P = 0.039). In patients with ACLF, the area under the curve (AUC) for PI was 0.680 (95% confidence intervals [CI], 0.52-0.85), which was significantly lower than that for the MELD score (AUC, 0.88; 95% CI, 0.77-0.99) (P = 0.04).
CONCLUSION
The PI can be an ancillary biomarker for predicting the development of ACLF and severe hepatic encephalopathy.

Keyword

Pallidal hyperintensity; Hepatic encephalopathy; Acute-on-chronic liver disease; Magnetic resonance imaging

MeSH Terms

Acute-On-Chronic Liver Failure
Female
Follow-Up Studies
Globus Pallidus
Hepatic Encephalopathy*
Humans
Liver Cirrhosis
Liver Diseases*
Liver*
Magnetic Resonance Imaging
Male
Retrospective Studies
White Matter

Figure

• 

  Fig. 1 ROI measurement for the PI. Standard ROIs placed in the globus pallidus on a non-enhanced T1-weighted image displays a high signal intensity globus pallidus. PI = pallidal index; ROI = region of interest

• 

  Fig. 2 Linear correlation between the signal intensity of the frontal white matter and globus pallidus, according to acute-on-chronic liver failure. ACLF = acute-on-chronic liver failure; SI frontal = T1 signal intensity on subcortical white matter; SI pallidus = T1 signal intensity on globus pallidus

• 

  Fig. 3 Comparison of the pallidal index in patients with hepatic encephalopathy according to ACLF. ACLF = acute-on-chronic liver failure; HE = hepatic encephalopathy

• 

  Fig. 4 Comparison of the MELD and PI to predict ACLF on a ROC curve. ACLF = acute-on-chronic liver failure; MELD = Model for End-Stage Liver Disease; PI = pallidal index; ROC = receiver operating characteristic

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