Correlation of Magnetic resonance brain imaging changes in chronic liver disease to manganese and ammonia levels

Hagag, Hany; El Amir, Mona; Esmat, Serag; Abdellatef, Abeer A; Rashed, Laila; Emad-Eldin, Sally

doi:10.21608/gg.2023.202093.1005

	Correlation of Magnetic resonance brain imaging changes in chronic liver disease to manganese and ammonia levels
Global Gastroenterology
Volume 1, Issue 1, August 2023 PDF (672.47 K)
Document Type: Original Articles
DOI: 10.21608/gg.2023.202093.1005
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Authors
Hany Hagag¹; Mona El Amir¹; Serag Esmat¹; Abeer A Abdellatef ²; Laila Rashed³; Sally Emad-Eldin⁴
¹Department of Internal Medicine, Faculty of Medicine, Cairo University, Egypt
²Internal Medicine department, Kasr Al-Aini Hospitals, Cairo University, Cairo Egypt. PO: 11451, Kasr Al-Aini street, Cairo Egypt.
³Department of Biochemistry and Molecular Biology, Faculty of Medicine, Cairo University, Egypt
⁴Department of Radiology, Faculty of Medicine, Cairo University, Egypt
Abstract
Background: Chronic liver disease patients may suffer from a wide spectrum of neuropsychiatric abnormalities that may be associated with cirrhosis and portal hypertension or portal-systemic shunts. Several neuroimaging techniques, especially MR imaging, could be useful for the diagnosis. Also, MRS can identify and measure various chemicals in the brain such as Choline (Cho), Myoinositol (MI), and glutamate-glutamine complex (Glx) that could be induced by liver injury. Aims: To study the changes in MR brain imaging in CLD and their correlation to manganese and ammonia levels. Methods: The study included 23 patients with CLD and ten healthy control subjects. MR brain was performed on all subjects including T1, T2, and FLAIR sequences, DWI and MRS. Grading of liver disease severity was done. Ammonia and manganese levels were measured in all patients. Results: Pallidal T1 Hyperintense signal was recognized in 15 patients. These signals correlated with the manganese levels (P=0.019). Hyperintense WMLs (white matter lesions) in FLAIR sequences were detected in 17 patients. MRS findings in patients with CLD included lower Cho/Cr and MI/Cr and higher Glx/Cr compared to controls (P < 0.05). Conclusions: MRI and MRS can be used to detect metabolic brain abnormalities in CLD patients and quantify the degree of neurotoxicity. MRI and spectroscopy abnormalities are related to biological abnormalities (Ammonia and Manganese) associated with CLD.
Keywords
Chronic Liver disease (CLD); lmagnetic resonance imaging (MRI); magnetic resonance spectroscopy (MRS); Ammonia (NH3); manganese (Mn)


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