title: 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.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Radiodiagnosis, Sanjay Gandhi Post Graduate Institute of Medical Sciences Raebareli Road, Lucknow, Uttar Pradesh 226014, India.
authors.forename: Vivek-A
authors.initials: VA
authors.lastname: Saraswat
authors.forename: Sona
authors.initials: S
authors.lastname: Saksena
authors.forename: Kavindra
authors.initials: K
authors.lastname: Nath
authors.forename: Pranav
authors.initials: P
authors.lastname: Mandal
authors.forename: Jitesh
authors.initials: J
authors.lastname: Singh
authors.forename: M-Albert
authors.initials: MA
authors.lastname: Thomas
authors.forename: Ramkishore-S
authors.initials: RS
authors.lastname: Rathore
authors.forename: Rakesh-K
authors.initials: RK
authors.lastname: Gupta
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000378:metabolism*; D002908:Chronic Disease; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007427:Intracranial Pressure; D017093:Liver Failure / Q000378:metabolism*; D017114:Liver Failure, Acute / Q000378:metabolism*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008353:Mannitol / Q000494:pharmacology*; D008875:Middle Aged
chemical_list: D008353:Mannitol