Evaluation of mannitol effect in patients with acute hepatic failure and acute-on-chronic liver failure using conventional MRI, diffusion tensor imaging and in-vivo proton MR spectroscopy

AIM： To evaluate the effect of an intravenous bolus of mannitol in altering brain metabolites, brain water content, brain parenchyma volume, cerebrospinal fluid （CSF） volume and clinical signs in controls and in patients with acute liver failure （ALF） and acute- on-chronic liver failure （ACLF）, by c...

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Published in:World journal of gastroenterology : WJG 2008-07, Vol.14 (26), p.4168-4178
Main Authors: Saraswat, Vivek-A, Saksena, Sona, Nath, Kavindra, Mandal, Pranav, Singh, Jitesh, Thomas, M-Albert, Rathore, Ramkishore-S, Gupta, Rakesh-K
Format: Article
Language:English
Subjects:
Adolescent
Adult
Basic Research
Brain - metabolism
Chronic Disease
Diffusion Magnetic Resonance Imaging - methods
Female
Humans
Intracranial Pressure
Liver Failure - metabolism
Liver Failure, Acute - metabolism
Magnetic Resonance Imaging - methods
Magnetic Resonance Spectroscopy - methods
Male
Mannitol - pharmacology
Middle Aged
急性肝衰竭
甘露醇
肝功能
质子MR光谱学
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Summary:AIM： To evaluate the effect of an intravenous bolus of mannitol in altering brain metabolites, brain water content, brain parenchyma volume, cerebrospinal fluid （CSF） volume and clinical signs in controls and in patients with acute liver failure （ALF） and acute- on-chronic liver failure （ACLF）, by comparing changes in conventional magnetic resonance imaging （MRI）, in vivo proton magnetic resonance spectroscopy （PMRS） and diffusion tensor imaging （DTI） before and after its infusion.METHODS： Five patients each with ALF and ACLF in grade 3 or 4 hepatic encephalopathy and with clinical signs of raised intracranial pressure were studied along with five healthy volunteers. After baseline MRI, an intravenous bolus of 20% mannitol solution was given over 10 min in controls as well as in patients with ALF and ACLE Repeat MRI for the same position was acquired 30 rnin after completing the rnannitol injection. RESULTS： No statistically significant difference was observed between controls and patients with ALF and ACLF in metabolite ratios, DTI metrics and brain volume or CSF volume following 45 rain of mannitol infusion. There was no change in clinical status at the end of post-mannitol imaging. CONCLUSION： The osmotic effect of mannitol did not result in significant reduction of brain water content, alteration in metabolite ratios or any change in the clinical status of these patients during or within 45 min of mannitol infusion.
ISSN:1007-9327
2219-2840
DOI:10.3748/wjg.14.4168