Wilson’s Disease and Clinical MR Imaging Application MR Imaging Analysis Two radiologists, each with more than seven years of experience in MR body imaging, retrospectively evaluated the MR images. The radiologists were blinded to the clinical and pathological findings. The two readers evaluated the MR images for (a) the presence and pattern of intrahepatic nodules, (b) the contour abnormalities of the liver and (c) additional findings such as a gallbladder abnormality, splenomegaly, venous collateral formation, or ascites. A three-point scoring system was used to evaluate the pattern of intrahepatic nodules as follows: 0 for none, 1 for granular (≤ 3 mm in diameter), and 2 for macronodular Table 1. Clinical Characteristics of 50 Patients with Wilson’s Disease Clinical Presentation Neurological Non-Neurological P value (n = 12) (n = 38) Male/female ratio 7:5 Age (years) at diagnosis 13.8±1.9 at MR examination 14.6±2.3 Kayser-Fleischer ring 11 (92%) Hepatic Function Child-Pugh class A 12 (100%) Child-Pugh class B 0 Child-Pugh class C 0 Treatment Untreated/treated 7:5 Duration of 2.8±1.8 treatment (years) 26:12 11.9±5.9 13.6±6.2 17 (45%) 24 (63%) 5 (13%) 9 (24%) 21:17 6.2±3.8 0.728 0.093 0.539 0.006 0.048 0.852 0.120 (> 3 mm in diameter) (Fig. 1). We evaluated the signal intensity of the nodules on T1-weighted images in compari- son to the underlying liver parenchyma. The various contour abnormalities of the liver identified included surface nodularity, gallbladder fossa widening, and caudate hypertrophy. Surface nodularity of the liver and the gallbladder fossa widening were assessed subjectively by the evaluation of irregularities along the liver surface and enlargement of the pericholecystic space (i.e., the gallblad- der fossa), respectively. Caudate hypertrophy was evaluated using a modified caudate-right lobe ratio (16). Twenty follow-up MR examinations obtained from 17 patients over a 10-year period (mean interval 28 months, range, 8-130 months) were also evaluated with the same MR interpretation protocols. Nine patients underwent MR imaging, before and after treatment, using copper chelating agents. In the eight remaining patients, both initial and follow-up MR examinations were obtained during treatment with copper chelating agents. Statistical Analysis The prevalence of the MR imaging findings was estimated as a percentage of the patients displaying each abnormality. The overall association between the MR findings and clinical presentations (neurological or non- neurological), or severity of hepatic dysfunction (Child- Pugh classification A, B, C), was assessed with a contin- gency table, employing the Chi-squared and Fisher’s exact tests. The association of clinical features for both clinical presentations was also evaluated by Chi-squared and Fisher’s exact probability tests. Differences in age and duration of treatment were compared for both groups of A B Fig. 2. 11-year-old girl diagnosed with Wilson’s disease (Child-Pugh class A). A. T2-weighted axial image shows multiple small hypointense nodules (≤ 3 mm in diameter, grade 1) in liver. B. Follow-up T2-weighted axial image obtained 18 months after D-penicillamine treatment shows near disappearance of hypointense nodules in liver. Korean J Radiol 11(6), Nov/Dec 2010 667