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
Article-Type of This Article
Basic Research
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Jul 14, 2008; 14(26): 4168-4178 Published online Jul 14, 2008. doi: 10.3748/wjg.14.4168
Table 1 Clinical profile of acute liver failure patients
Case
Age/Sex
Etiology
Grade of HE
Jaundice-HE interval (d)
HE duration at presentation (d)
Clinical features of raised ICP
DP
HT
B
PC
NH
1
24/M
Hepatitis E
4
7
2
+
+
-
-
+
2
14/M
Hepatitis B
4
8
2
+
+
-
+
+
3
24/F
Hepatitis B
4
23
2
+
+
+
+
+
4
46/F
Hepatitis E
4
2
2
+
+
+
+
+
5
25/F
Hepatitis E
3
2
1
+
+
-
-
-
Table 2 Biochemical profile of acute liver failure patients
Case
Serum bilirubin (mg/dL)
ALT (U/L)
AST (U/L)
ALP (U/L)
INR
Serum sodium (mmol/L)
Serum potassium (mmol/L)
Serum creatinine (mg/dL)
Blood sugar (mg/dL, range)
Blood ammonia (&mgr;mol/dL)
1
13.3
242
349
134
1.8
142
3.8
1.2
110-186
2
26.4
1020
920
120
8.2
146
4.7
1.2
130-194
438
3
28.6
206
156
140
6.8
140
4.9
0.6
98-178
150
4
15.3
1688
276
210
5.5
145
4.3
0.6
130-188
265
5
21.5
232
142
146
2.8
143
3.6
0.4
88-176
182
Table 3 Clinical profile of acute-on-chronic liver failure patients
Case
Age/Sex
Etiology
Grade of HE
Jaundice-HE interval (d)
HE duration at presentation (d)
Clinical features of raised ICP
Acute
Chronic
DP
HT
B
PC
NH
1
48/M
Hepatitis E
Cryptogenic
3
17
2
+
+
-
-
+
2
48/M
Hepatitis E
Chronic Hepatitis B
4
15
3
+
+
-
+
+
3
24/F
Hepatitis E
Autoimmune
3
22
1
+
-
-
-
+
4
45/F
Hepatitis E
Chronic Hepatitis C
3
13
2
+
+
-
+
+
5
28/F
Hepatitis E
Chronic Hepatitis B
3
7
2
+
+
-
-
+
Table 4 Biochemical profile of acute-on-chronic liver failure patients
Case
Serum bilirubin (mg/dL)
ALT (U/L)
AST (U/L)
SAP (U/L)
INR
Serum sodium (mmol/L)
Serum potassium (mmol/L)
Serum creatinine (mg/dL)
Blood sugar (mg/dL, range)
Blood ammonia (&mgr;mole/dL)
Child score
MELD score
1
18.8
346
274
148
2.6
143
3.7
1.2
130-194
180
12/15
30
2
17.2
254
142
165
2.4
144
4.9
0.9
98-210
280
13/15
29
3
25.7
636
524
164
3.7
136
4.5
0.5
98-166
261
13/15
33
4
25.1
240
320
97
3.9
145
3.9
0.9
108-210
310
14/15
34
5
10.2
279
151
79
2.25
137
4.3
0.8
89-189
210
13/15
24
Table 5 Peak integrals relative to those of creatine (mean ± SD) in right parietal white and gray matter in healthy controls, acute liver failure (ALF) patients and acute-on-chronic liver failure (ACLF) patients before the intravenous infusion of mannitol (pre-mannitol study) and after receiving mannitol (post-mannitol study)
Metabolites
Study
Control (n = 5)
ALF patient (n = 5)
ACLF patient (n = 5)
Pre-mannitol
Post-mannitol
P
Pre-mannitol
Post-mannitol
P
Pre-mannitol
Post-mannitol
P
NAA/Cr
1.25 ± 0.16
1.23 ± 0.17
0.92
1.20 ± 0.13
1.27 ± 0.32
0.75
0.90 ± 0.35
0.58 ± 0.29
0.18
Cho/Cr
0.24 ± 0.06
0.24 ± 0.08
0.75
0.18 ± 0.09
0.16 ± 0.07
0.47
0.20 ± 0.05
0.20 ± 0.03
0.75
Gln/Cr
1.44 ± 1.06
1.18 ± 0.94
0.35
3.04 ± 1.32
2.52 ± 1.56
0.25
1.44 ± 0.30
2.42 ± 1.44
0.60
Glx/Cr
2.84 ± 0.98
2.70 ± 1.21
0.60
4.46 ± 1.48
4.38 ± 1.61
0.92
2.85 ± 0.70
3.85 ± 2.13
0.35
mI/Cr
0.57 ± 0.48
0.49 ± 0.34
0.92
0.56 ± 0.15
0.47 ± 0.16
0.18
0.41 ± 0.17
0.89 ± 1.14
0.81
Table 6 Summary of fractional anisotropy values (mean ± SD) from different white and gray matter regions in controls, patients with acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) before the intravenous infusion of mannitol (pre-mannitol study) and after receiving mannitol (post-mannitol study)
Region
Study
Control (n = 5)
ALF patient (n = 5)
ACLF patient (n = 5)
Pre-mannitol
Post-mannitol
P
Pre-mannitol
Post-mannitol
P
Pre-mannitol
Post-mannitol
P
ALIC
0.36 ± 0.05
0.37 ± 0.04
0.60
0.30 ± 0.03
0.30 ± 0.02
0.47
0.32 ± 0.02
0.33 ± 0.02
0.56
PLIC
0.49 ± 0.05
0.48 ± 0.05
0.60
0.33 ± 0.02
0.34 ± 0.01
0.12
0.45 ± 0.03
0.40 ± 0.03
0.08
CN
0.11 ± 0.00
0.11 ± 0.00
0.47
0.09 ± 0.01
0.09 ± 0.01
0.60
0.08 ± 0.01
0.09 ± 0.01
0.56
P
0.09 ± 0.01
0.09 ± 0.01
0.92
0.06 ± 0.01
0.07 ± 0.01
0.92
0.06 ± 0.02
0.08 ± 0.01
0.15
TH
0.15 ± 0.01
0.14 ± 0.01
0.12
0.12 ± 0.00
0.12 ± 0.01
0.92
0.14 ± 0.01
0.15 ± 0.03
0.77
FWM
0.31 ± 0.03
0.30 ± 0.03
0.92
0.30 ± 0.03
0.32 ± 0.07
0.92
0.32 ± 0.04
0.36 ± 0.07
0.56
OWM
0.38 ± 0.06
0.38 ± 0.07
0.92
0.38 ± 0.04
0.37 ± 0.05
0.92
0.35 ± 0.04
0.31 ± 0.02
0.15
CC
0.53 ± 0.04
0.54 ± 0.06
0.92
0.44 ± 0.06
0.45 ± 0.02
0.35
0.50 ± 0.04
0.51 ± 0.05
0.77
Cingulum
0.36 ± 0.03
0.37 ± 0.04
0.75
0.44 ± 0.07
0.41 ± 0.03
0.25
0.38 ± 0.03
0.36 ± 0.03
0.56
Frontal cortex
0.12 ± 0.01
0.11 ± 0.00
0.47
0.12 ± 0.04
0.12 ± 0.04
0.60
0.14 ± 0.02
0.11 ± 0.02
0.08
Parietal cortex
0.12 ± 0.01
0.12 ± 0.01
0.75
0.11 ± 0.01
0.10 ± 0.01
0.75
0.14 ± 0.01
0.11 ± 0.03
0.39
Occipital cortex
0.11 ± 0.02
0.12 ± 0.03
0.47
0.14 ± 0.05
0.10 ± 0.03
0.25
0.10 ± 0.05
0.13 ± 0.03
0.39
Table 7 Summary of mean diffusivity values (mean ± SD) in units of 10-3 mm2/s from different white and gray matter regions in controls, patients with acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) before the intravenous infusion of mannitol (pre-mannitol study) and after receiving mannitol (post-mannitol study)
Region
Study
Control (n = 5)
ALF patient (n = 5)
ACLF patient (n = 5)
Pre-mannitol
Post-mannitol
P
Pre-mannitol
Post-mannitol
P
Pre-mannitol
Post-mannitol
P
ALIC
0.76 ± 0.07
0.76 ± 0.05
0.60
0.68 ± 0.02
0.68 ± 0.02
0.75
0.72 ± 0.02
0.71 ± 0.08
0.56
PLIC
0.74 ± 0.06
0.75 ± 0.05
0.75
0.67 ± 0.03
0.67 ± 0.02
0.92
0.65 ± 0.03
0.65 ± 0.04
0.77
CN
0.73 ± 0.02
0.74 ± 0.02
0.75
0.68 ± 0.01
0.69 ± 0.02
0.92
0.69 ± 0.02
0.69 ± 0.09
0.25
P
0.69 ± 0.01
0.70 ± 0.06
0.25
0.64 ± 0.03
0.63 ± 0.01
0.47
0.69 ± 0.02
0.69 ± 0.06
0.39
TH
0.72 ± 0.03
0.71 ± 0.03
0.92
0.66 ± 0.02
0.66 ± 0.04
0.92
0.71 ± 0.02
0.74 ± 0.05
0.56
FWM
0.77 ± 0.06
0.76 ± 0.07
0.75
0.67 ± 0.01
0.66 ± 0.05
0.92
0.65 ± 0.02
0.66 ± 0.13
0.25
OWM
0.76 ± 0.05
0.76 ± 0.07
0.92
0.66 ± 0.03
0.66 ± 0.05
0.75
0.76 ± 0.11
0.68 ± 0.05
0.56
CC
0.74 ± 0.07
0.74 ± 0.07
0.92
0.74 ± 0.09
0.74 ± 0.08
0.92
0.77 ± 0.09
0.77 ± 0.09
0.77
Cingulum
0.72 ± 0.05
0.72 ± 0.09
0.75
0.72 ± 0.10
0.72 ± 0.04
0.75
0.73 ± 0.03
0.70 ± 0.06
0.56
Frontal cortex
0.69 ± 0.07
0.69 ± 0.04
0.92
0.68 ± 0.04
0.68 ± 0.05
0.92
0.65 ± 0.05
0.70 ± 0.03
0.08
Parietal cortex
0.68 ± 0.06
0.68 ± 0.05
0.92
0.68 ± 0.01
0.68 ± 0.03
0.47
0.69 ± 0.04
0.63 ± 0.04
0.08
Occipital cortex
0.67 ± 0.07
0.67 ± 0.06
0.92
0.66 ± 0.02
0.66 ± 0.05
0.92
0.69 ± 0.06
0.62 ± 0.03
0.15
Table 8 Change in brain volume and cerebrospinal fluid (CSF) volume values (mean ± SD) in units of cubic centimeter from different white and gray matter regions in controls, patients with acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) before the intravenous infusion of mannitol (pre-mannitol study) and after receiving mannitol (post-mannitol study)
Volume
Study
Control (n = 5)
ALF Patient (n = 5)
ACLF Patient (n = 5)
Pre-mannitol
Post-mannitol
P
Pre-mannitol
Post-mannitol
P
Pre-mannitol
Post-mannitol
P
Brain volume
1303.47 ± 54.95
1308.88 ± 64.95
0.75
1130.76 ± 86.73
1162.39 ± 77.75
0.47
1096.85 ± 79.55
1076.90 ± 71.63
0.60
CSF volume
84.05 ± 4.88
85.10 ± 6.46
0.60
73.77 ± 19.72
73.27 ± 19.53
0.47
76.77 ± 18.68
83.84 ± 22.09
0.12
Citation: 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