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While hepatic symptoms typically precede the neurological manifestations, copper accumulates in the brain already in this patient group and leads to subclinical brain MRI abnormalities including T2 hyperintensities and atrophy. This study aimed to assess brain morphological changes in mild hepatic WD. WD patients without a history of neurologic symptoms and decompensated cirrhosis and control participants underwent brain MRI at 3T scanner including high\u2010resolution T1\u2010weighted images. A volumetric evaluation was conducted on the following brain regions: nucleus accumbens, caudate, pallidum, putamen, thalamus, amygdala, hippocampus, midbrain, pons, cerebellar gray matter, white matter (WM), and superior peduncle, using Freesurfer v7 software. Whole\u2010brain analyses using voxel\u2010 and surface\u2010based morphometry were performed using SPM12. Statistical comparisons utilized a general linear model adjusted for total intracranial volume, age, and sex. Twenty\u2010six WD patients with mild hepatic form (30\u2009\u00b1\u20099\u2009years [mean age\u2009\u00b1\u2009SD]); 11 women; mean treatment duration 13\u2009\u00b1\u200912 (range 0\u201342) years and 28 healthy controls (33\u2009\u00b1\u20099\u2009years; 15 women) were evaluated. Volumetric analysis revealed a significantly smaller pons volume and a trend for smaller midbrain and cerebellar WM in WD patients compared to controls. Whole\u2010brain analysis revealed regions of reduced volume in the pons, cerebellar, and lobar WM in the WD group. No significant differences in gray matter density or cortical thickness were found. Myelin or WM in general seems vulnerable to low\u2010level copper toxicity, with WM volume loss showing promise as a marker for assessing brain involvement in early WD stages.<\/jats:p>","DOI":"10.1002\/jimd.12814","type":"journal-article","created":{"date-parts":[[2024,11,19]],"date-time":"2024-11-19T19:24:25Z","timestamp":1732044265000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Brain morphometry in hepatic Wilson disease patients"],"prefix":"10.1002","volume":"48","author":[{"given":"Parya","family":"Rahimi","sequence":"first","affiliation":[{"name":"Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine Charles University and General University Hospital in Prague  Prague Czechia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanislav","family":"Mare\u010dek","sequence":"additional","affiliation":[{"name":"Department of Neurology and Center of Clinical 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