Saraswat VA, Saksena S, Nath K, Mandal P, Singh J, Thomas MA, Rathore RS, Gupta RK. 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. World J Gastroenterol 2008; 14(26): 4168-4178 [PMID: 18636662 DOI: 10.3748/wjg.14.4168]
Corresponding Author of This Article
Dr. Rakesh K Gupta, Professor, Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences Raebareli Road, Lucknow, Uttar Pradesh 226014, India. rgupta@sgpgi.ac.in, rakeshree@hotmail.com
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Basic Research
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World J Gastroenterol. Jul 14, 2008; 14(26): 4168-4178 Published online Jul 14, 2008. doi: 10.3748/wjg.14.4168
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
Vivek A Saraswat, Sona Saksena, Kavindra Nath, Pranav Mandal, Jitesh Singh, M Albert Thomas, Ramkishore S Rathore, Rakesh K Gupta
Vivek A Saraswat, Pranav Mandal, Department of Gastroen-terology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
Sona Saksena, Kavindra Nath, Rakesh K Gupta, Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh 226014, India
Jitesh Singh, Ramkishore S Rathore, Department of Mathematics and Statistics, Indian Institute of Technology, Kanpur, Uttar Pradesh 226014, India
M Albert Thomas, Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Los Angeles, California 90095-1721, United States
Author contributions: Gupta RK, Saraswat VA, Saksena S, Rathore RS and Thomas MA designed the study; Gupta RK, Saraswat VA, Nath K and Mandal P collected the data; Gupta RK, Saraswat VA, Saksena S, Rathore RS, Nath K and Singh J analyzed the data; Gupta RK, Saraswat VA, Rathore RS and Thomas MA interpreted the data; Gupta RK, Saraswat VA, Saksena S, Rathore RS and Thomas MA contributed to the writing of the manuscript; Gupta RK decided to submit the manuscript for publication
Correspondence to: Dr. Rakesh K Gupta, Professor, Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences Raebareli Road, Lucknow, Uttar Pradesh 226014, India. rgupta@sgpgi.ac.in, rakeshree@hotmail.com
Telephone: +91-522-2668700
Fax: +91-522-2668017
Received: February 25, 2008 Revised: May 16, 2008 Accepted: May 23, 2008 Published online: July 14, 2008
Abstract
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 ACLF. Repeat MRI for the same position was acquired 30 min after completing the mannitol 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 min 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.
