Relationship of Biological Indices of Manganese with Pallidal Index on MRI in Liver Cirrhotics / 대한산업의학회지

OBJECTIVES: The objectives of this study were to clarify which biological manganese exposure indices reflect the pallidal signal intensities in magnetic resonance imaging (MRI) in liver cirrhotics. METHODS: We examined whole blood, plasma, RBC and urinary manganese concentrations, as well as, brain MRI in 22 cirrhotic patients and 10 healthy controls. From MRI scans we calculated the signal intensity of the globus pallidus using the pallidal index (PI), the ratio of the globus pallidus to subcortical frontal white-matter signal intensity in axial T1-weighted MRI planes multiplied by 100. In addition, we studied the relationships between PI and other measurements. RESULTS: The high signal intensity in the globus pallidus on T1-weighted MRI was observed in 18 (81.8%) patients. There was a significant correlation between whole blood and RBC manganese concentration, and PI on MRI. According to multiple linear regression, whole blood and RBC manganese concentration reflected PI on MRI better the other indices did. CONCLUSIONS: Whole blood and RBC manganese concentrations could be useful as biological manganese exposure indices that reflect PI on MRI.

Relationship to Magnetic Resonance Signal Hyperintensity in Globus Palidus and Blood Manganese Concentration in Cirrhotic Patients with Extrapyramidal Symptoms / 대한간학회지

BACKGROUND/AIMS: Increasing evidence suggests that manganese deposition in globus pallidus is responsible for MRI signal hyperintensity and for extrapyramidal symptoms in cirrhotics. However, the relationships between blood manganese, the severity of liver dysfunction, the pallidal signal intensity, and neurological signs have not been well established. METHODS: Blood manganese concentrations were measured together with brain MRI and neurological evaluation in six controls, six patients with Parkinson's disease with normal liver function, and fourteen cirrhotic patients with hepatic encephalopathy including six cirrhotics with extrapyramidal symptoms. The neurological state was evaluated using the Columbia scale and the pallidal index (PI). The ratio of globus pallidus to frontal subcortical white-matter signal intensity was measured-multiplied by 100. RESULTS: Pallidal signal hyperintensity was observed in 85.7% of cirrhotics, and the PI was higher in cirrhotics with extrapyramidal signs or high grade varices than those without them, but there was no increase in the Parkinson's disease patients. No correlations were demonstrated between the blood manganese level and PI as well as the Child-Pugh score. The blood manganese level was not significantly different between cirrhotics and other groups. However, there was an overt increase only in two cirrhotic patients with extrapyramidal signs. The Columbia scale did not reveal any correlations with the blood manganese level and the Child-Pugh score. CONCLUSIONS: Cirrhotics with extrapyramidal signs showed a significant increase in PI, but there was no increase in the patients with Parkinson's disease. The PI was not significantly correlated with the blood manganese level. These findings suggest that extrapyramidal signs in cirrhotics might be caused by a different mechanism than those in Parkinson's disease, which could possibly be related with manganese.