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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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World Journal of Gastroenterology 2008年第26期14卷 4168-4178页

作者： Vivek A Saraswat Sona Saksena Kavindra Nath pranav mandal Jitesh Singh M Albert Thomas Ramkishore S Rathore Rakesh K Gupta Department of Gastroen-terology Sanjay Gandhi Post Graduate Institute of Medical SciencesLucknowUttar Pradesh 226014India Department of Radiodiagnosis Sanjay Gandhi Post Graduate Institute of Medical SciencesLucknowUttar Pradesh 226014 India Department of Gastroen-terology Sanjay Gandhi Post Graduate Institute of Medical SciencesLucknowUttar Pradesh 226014 India Department of Mathematics and Statistics Indian Institute of TechnologyKanpurUttar Pradesh 226014India Department of Radiological Sciences David Geffen School of Medicine at UCLA10833 Le Conte AvenueLos AngelesCalifornia 90095-1721United States Department of Mathematics and Statistics Indian Institute of TechnologyKanpurUttar Pradesh 226014India Department of Radiodiagnosis Sanjay Gandhi Post Graduate Institute of Medical SciencesLucknowUttar Pradesh 226014 India

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 ***： 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.

关键词： Mannitol Acute liver failure Acute-on-chronic liver failure Proton MR spectroscopy Diffusion tensor imaging

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