Comparison of brain magnetic resonance imaging findings before and after liver transplantation
Feride Kural Rahatli1, Gokhan Kahraman1, Fuldem Yildirim Donmez1, Aydincan Akdur2, Ahmet Muhteşem Agildere1, Mehmet Haberal2
1Baskent University Faculty of Medicine Department of Radiology, Ankara, Turkey
2Baskent University Faculty of Medicine Department of General Surgery, Ankara, Turkey
Aim: The purpose was to compare the brain Magnetic Resonance Imaging (MRI) findings of the liver transplant recipients who had a neurological symptom, before and after liver transplantation.
Material and Methods: Patients were evaluated in the terms of age, gender, etiology of chronic liver disease and the clinical symptoms. The brain MRI findings before and after liver transplantation were compared.
Results: Thirty liver transplant patients with brain MRIs before and after liver transplantation were included. Hyper intensities on T1 weighted images which is compatible with manganese deposition in the basal ganglia was found from the first brain MRI of 18 patients. In thirteen of them the deposition was disappeared or decreased but in five of them the deposition persisted after transplantation. Hyper intensities on T2 weighted images which is compatible with copper deposition in the basal ganglia of four patients with Wilson’s disease persisted after transplantation. Five patients who had normal brain MRI findings before transplantation had posterior reversible encephalopathy syndrome (PRES) after the transplantation. One patient had focal cerebritis, three patients had acute infarct and one patient had intraparenchymal hemorrhage after transplantation.
Conclusion: Most of the neurological symptoms during chronic liver disease are associated with the deposition of paramagnetic substances. After transplantation there could be regression in manganese deposition but the copper deposition stayed the same. Post-transplant PRES, central nervous system infections, infarct, and hemorrhage were not rare. Pre and post-transplant patients with neurological symptoms should be evaluated with brain MRI for rapid diagnosis and proper management.