Bilateral basal ganglia T1 hyperintensity

Left image shows normal T1 signal intensity of Globus Pallidus, where as
right T1 axial image in a 54yr old male with known chronic liver disease
 shows bilateral globus pallidus T1 hyperintensity.

 

Right image: Another CLD patient with bilateral T1 hyperintensity of Globus Pallidus.

Common causes of bilateral T1 hyperintense basal ganglia include:
1. Physiologic calcification.
2. NF-1
3. Hepatic Encephalopathy.
4. Hyperalimentation (Patients undergoing parenteral feeding).

Less common causes:
1.HIE (Term HIE, Hypoxic cerebral infarction).
2. CO poisoning.
3. Kernicterus.
4. Wilson's Disease.

Rarely thyroid / parathyroid hormonal imbalances, hypoglycemia, Fahr's disease, Hallervorden-Spatz syndrome, JE, Congenital HIV etc. also may cause T1 hyperintensity of the basal ganglia.

In chronic liver disease / cirrhotic patients there is symmetrical T1 hyperintensity in Globus Pallidus and Substantia Nigra.


References:
1. Expert-DDx Brain.

Tumoral Thrombosis of Portal Vein

Patient is a 50 year old female patient.

Liver echotexture is coarse in this case, with moderately dilated portal vein - consistent with Chronic parenchymal disease with Portal hypertension. Echogenic thrombus was seen filling the right and left branches of Main Portal Vein. On color doppler interrogation, the thrombus showed markedly increased vascularity, derived from hepatic artery. There was also a hypoechoic lesion, difficult to visualize, because of its location in the superior most portion of segment VIII of right lobe.

Below is a video of the case showing the color uptake by the thrombus.