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.
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.
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DOI：
10.3748/wjg.14.4168
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发表时间：
2008-07
影响因子：
4.3
通讯作者：
V. Saraswat;S. Saksena;K. Nath;P. Mandal;J. Singh;M. Thomas;R. Rathore;Rakesh K. Gupta
中科院分区：
文献类型：
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作者：
V. Saraswat;S. Saksena;K. Nath;P. Mandal;J. Singh;M. Thomas;R. Rathore;Rakesh K. Gupta
目的通过比较常规磁共振成像（MRI）的变化，评价静脉推注甘露醇对对照组、急性肝衰竭（ALF）和慢加急性肝衰竭（ACLF）患者脑代谢产物、脑含水量、脑实质体积、脑脊液（CSF）体积和临床体征的影响，输注前后的体内质子磁共振谱（PMRS）和扩散张量成像（DTI）。方法沿着5例健康志愿者，分别为5例ALF和5例ACLF，均为3~4级肝性脑病，临床表现为颅内压增高。在基线MRI后，对照组以及ALF和ACLF患者在10分钟内静脉推注20%甘露醇溶液。在完成甘露醇注射后30分钟，对相同位置进行重复MRI。结果对照组与ALF和ACLF患者在甘露醇输注45 min后的代谢物比率、DTI指标和脑体积或CSF体积方面无统计学显著差异。甘露醇后成像结束时临床状态无变化。结论甘露醇的渗透作用在45 min内未引起脑含水量的显著降低、代谢物比例的改变或临床状态的任何改变。
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.