Cerebral MR imaging in patients with primary biliary cirrhosis

: Five patients with primary biliary cirrhosis (PBC) underwent cerebral magnetic resonance (MR) imaging to evaluate subclinical hepatocerebral degeneration. All patients were neurologically asymptomatic, but three of the five patients had symptoms such as jaundice and itching. Symmetrically hyperintense globus pallidi were observed on T1-weighted images in four of the five patients. One remaining patient who had normal MR images was an asymptomatic fresh case. Patients with markedly hyperintense globus pallidi also had mildly increased signal intensities in the surrounding structures. On proton-density- and T2-weighted images, there were no abnormal signals in the globus pallidi any of the patients. Portal-systemic collateral vessels were demonstrated in three of the four patients with abnormal MR images. The mechanisms by which T1-shortening of the globus pallidi occurs remains obscure. We believe that both portal-systemic collaterals and cholestasis play a prominent role in the cause of cerebral abnormalities on T1-weighted images.