Cheon et al. tent with cirrhosis have been reported in the literature (12- 14). However, the clinical applications of MR imaging features of the liver in Wilson’s disease have not yet been established. The purpose of this study was to evaluate the morphological features of the liver on MR images obtained in patients with Wilson’s disease, and determine whether there is a correlation between the MR findings and clinical manifestations and severity of hepatic dysfunction. MATERIALS AND METHODS Patients MR images of the liver were retrospectively reviewed alongside clinical findings in 50 children and young adults with Wilson’s disease (M:F = 33:17; age range, 5-26 years; median age, 14 years). The database of the computed hospital information system was cross-referenced with the MR imaging database to identify all patients with Wilson’s disease who had undergone MR imaging of the liver at the institution over the course of a 10-year period from January 1997 to January 2007. The institutional review board approved the review of the radiological and clinical data for this study and waived the requirement for patient informed consent. Wilson’s disease was diagnosed based on a combination of low serum ceruloplasmin levels accompanied with elevated 24-hour urinary copper excretion (n = 50), as well as the presence of a Kayser- Fleischer (K-F) ring (n = 28), and a liver biopsy (n = 12). Patients were classified at the time of diagnosis as having neurological (either current clinical or historical evidence of neurological dysfunction which was not associated with symptomatic liver disease) and non-neurological presenta- tion, including hepatic (an increase in serum transaminase levels, acute/chronic hepatitis or cirrhosis) and asympto- matic presentation (siblings of index cases with no disease- related symptoms) (6). The hepatic function of the each patient was categorized into three groups (class A, B and C) according to the Child-Turcotte-Pugh score (5 to 15- point scale) (15). Twenty-two patients had been treated with copper chelators, D-penicillamine (n = 16), or trientine (n = 6) (median duration of treatment: 6 years, range: 0.5-12 years) at the time of MR imaging. Another 28 patients were diagnosed with Wilson’s disease at the time of MR imaging and was administered any copper chelating agents. The clinical characteristics of the patients were summarized in Table 1. All patients were followed at the pediatric outpatient clinic, and follow-up MR images were available for 17 patients. MR Imaging All examinations were obtained using 1.0 or 1.5 Tesla MR scanners (Siemens Medical Systems, Erlangen, Germany). This retrospective data collection was preceded by the various MR imaging protocols for the liver. However, the studies included the following MR sequences: an axial T2-weighted fast spin-echo sequence (repetition time msec/echo time msec, 3500-5000/96-144) and an axial T1-weighted spin echo sequence (repetition time msec/echo time msec, 410-530/1.5-2.2) with a 7 mm thickness, 1-2-mm gap, 256 × 256 matrix size and field- of-view, 240 × 320. A B Fig. 1. Interpretation of intrahepatic nodules in Wilson’s disease on T2-weighted images (TR/TE = 3500/100) A. 9-year-old girl with Wilson’s disease and elevated liver enzymes (Child-Pugh class A) shows innumerable tiny, hypointense nodules (≤ 3 mm in diameter, grade 1) in liver on T2-weighted image. B. 24-year-old woman with Wilson’s disease who presented with jaundice (Child-Pugh class B) shows innumerable hypointense nodules (> 3 mm in diameter, grade 2) on T2-weighted image. 666 Korean J Radiol 11(6), Nov/Dec 2010