Magnetic resonance imaging measurement of brain edema in patients with liver disease:: resolution after transplantation

Purpose of review Results from experimental studies indicate that widespread osmotic disturbance induced by astrocytic accumulation of glutamine as a result of ammonia detoxification may lead to brain edema, not only in cases of fulminant hepatic failure, but in the entire spectrum of liver disease. This review summarizes recent magnetic resonance imaging data obtained in patients with chronic liver failure before and after liver transplantation that support the hypothesis that mild brain edema exists in these patients in the absence of clinical hepatic encephalopathy. Recent findings Diffuse white matter abnormalities have been detected with several magnetic resonance imaging techniques such as magnetization transfer ratio measurements, which show significantly low values in otherwise normal appearing brain white matter, and fast-Flair sequences, which show abnormal high-signal intensity of the hemispheric white matter tracts. Both these abnormalities return to normal with restoration of liver function, indicating their reversibility and supporting the hypothesis that they reflect mild diffuse brain edema. Summary It is likely that magnetic resonance imaging will be increasingly used to evaluate the mechanisms involved in the pathogenesis of hepatic encephalopathy and to assess the effects of therapeutic measures focused on correcting astrocyte swelling in these patients.