The results of MRI of the brain in adults with non-Wilsonian chronic hepatic failure are reported. T1-weighted images demonstrated increased signal in the basal ganglia. These abnormalities are strikingly similar to those seen following manganese (Mn) intoxication. The causes of this high signal have been thought to include paramagnetic substances, especially Mn, which accumulates within the basal ganglia in liver cirrhosis, because of its increased concentration in whole blood. Mn neurotoxicity may contribute to the development of chronic hepatic encephalopathy so that therapies which prevent or reduce Mn overload may have clinical benefit.
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