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Blood Manganese Correlates with Brain Magnetic Resonance Imaging Changes in Patients with Liver Disease

Published online by Cambridge University Press:  18 September 2015

Robert A. Hauser ,
Theresa A. Zesiewicz ,
Carlos Martinez ,
Alexander S. Rosemurgy  and
C.W. Olanow
Robert A. Hauser
Affiliation:
Department of Neurology, University of South Florida, Tampa, Florida
Theresa A. Zesiewicz
Affiliation:
Department of Neurology, University of South Florida, Tampa, Florida
Carlos Martinez
Affiliation:
Department of Radiology, University of South Florida, Tampa, Florida
Alexander S. Rosemurgy
Affiliation:
Department of Surgery, University of South Florida, Tampa, Florida
C.W. Olanow*
Affiliation:
Department of Neurology, Mount Sinai School of Medicine (C.W.O.), New York, New York
*
Department of Neurology. Mount Sinai School of Medicine, 1 Gustave L. Levy Place, Box 1137. New York, New York 10029 USA
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Abstract:

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Background: Chronic liver failure is associated with high signal abnormalities in the basal ganglia on Tl-weighted magnetic resonance imaging of the brain. These abnormalities are strikingly similar to those seen following manganese intoxication. As dietary manganese is normally cleared by the liver, we hypothesize that hepatic dysfunction could lead to manganese overload and account for the MR1 abnormalities seen in patients with chronic liver disease. Methods: We measured blood manganese concentrations in eleven patients with biopsy-proven hepatic cirrhosis and eleven healthy age and sex-matched controls. We also performed semi-quantitative measures of Tl signal abnormalities on MRI in the patients with chronic liver disease. Results: Patients with cirrhosis had significantly higher blood manganese concentrations (20.6 ± 10.2 mcg/L) than controls (7.2 ± 2.7, p = .0013). In addition, semi-quantitative scores of TI-weighted signal hyperintensity on MRI correlated with blood manganese concentration in patients with cirrhosis (r = .65, p = .029). Conclusions: These findings demonstrate that chronic liver disease is associated with manganese overload and suggest that manganese is responsible for the Tl-weighted signal hyperintensity seen on MRI of patients with liver disease. As manganese intoxication is known to cause parkinsonism and an encephalopathy similar to those which occur with chronic liver disease, it is possible that manganese toxicity contributes to the development of these symptoms in liver damaged patients and that therapies which prevent or reduce manganese overload may have clinical benefit.

Type
Original Articles
Information
Canadian Journal of Neurological Sciences , Volume 23 , Issue 2 , February 1996 , pp. 95 - 98
Copyright
Copyright © Canadian Neurological Sciences Federation 1996

References

1.Brunberg, JA, Kanal, E, Hirsch, W, Van Thiel, DH.Chronic acquired hepatic failure: MR imaging of the brain at 1.5 T. Am J Neuroradiol 1991; 12:909–914.Google ScholarPubMed
2.Inoue, E, Shinichi, H, Narumi, Y, et al. Portal-systemic encephalopathy: presence of basal ganglia lesions with high signal intensity on MR images. Radiology 1991; 179: 551–555.CrossRefGoogle ScholarPubMed
3.Kulisevsky, J, Pujol, J, Junque, C, et al. MRI pallidal hyperintensity and brain atrophy in cirrhotic patients: two different MRI patterns of clinical deterioration? Neurology 1993; 43: 2570–2573.CrossRefGoogle ScholarPubMed
4.Young, SW.Nuclear Magnetic Resonance Imaging. Basic Principles. New York: Raven Press, 1984.Google Scholar
5.Gomori, JM, Grossman, RI, Goldberg, HI, et al. Intracranial hematomas: imaging by high-field MR. Radiology 1985; 157: 87–93.CrossRefGoogle ScholarPubMed
6.Gomori, JM, Grossman, RI, Shields, JA, et al. Choroidal melanomas: correlation of NMR spectroscopy and MR imaging. Radiology 1986; 158:443–445.CrossRefGoogle ScholarPubMed
7.Dell, LA, Brown, MS, Orrison, WW, Eckel, CG, Matwiyoff, NA.Physiologic intracranial calcification with hyperintensity on MR imaging: case report and experimental model. Am J Neuroradiol 1988; 9: 1145–1148.Google ScholarPubMed
8.Mirowitz, SA, Sartor, K, Gado, M.High-intensity basal ganglia lesions on Tl-weighted MR images in neurofibromatosis. Am J Neuroradiol 1989; 10: 1159–1163.Google Scholar
9.Newland, MC, Ceckler, TL, Kordower, JH, Weiss, B.Visualizing manganese in the primate basal ganglia with magnetic resonance imaging. Exp Neurol 1989; 106: 251–258.CrossRefGoogle ScholarPubMed
10.Shinotoh, H, Snow, B, Hewitt, KA, et al. MRI and PET studies of manganese-intoxicated monkeys. Neurology 1995; 45: 1199–1204.CrossRefGoogle ScholarPubMed
11.Hauser, RA, Zesiewicz, TA, Rosemurgy, AS, Martinez, C, Olanow, CW.Manganese intoxication and chronic liver failure. Ann Neurol 1994; 36:871–875.CrossRefGoogle ScholarPubMed
12.Altman, D.Practical Statistics for Medical Research. New York: Chapman and Hall, 1991.Google Scholar
13.Versieck, J, Barbler, F, Speecke, A, Hoste, J.Manganese, copper and zinc concentrations in serum and packed blood cells during acute hepatitis, chronic hepatitis and posthepatitic cirrhosis. Clin Chem 1974; 20: 1141–1145.CrossRefGoogle ScholarPubMed
14.Larsen, NA, Pakkenberg, H, Damsgaard, E, Heydorn, K.Topographical distribution of arsenic, manganese, and selenium in the normal human brain. J. Neurol Sci 1979; 42: 407–416.CrossRefGoogle ScholarPubMed
15.Bonilla, E, Salazar, E, Joaquin, J, et al. The regional distribution of manganese in the normal human brain. Neurochem Res 1982; 7: 221–227.CrossRefGoogle ScholarPubMed
16.Baruthio, F, Guillard, O, Arnaud, J, Pierre, F, Zawislak, R.Determination of manganese in biological materials by electrothermal atomic absorption spectroscopy: a review. Clin Chem 1988; 34:227–234.CrossRefGoogle ScholarPubMed
17.Greger, JL, Davis, CD, Suttie, JW, Lyle, BJ.Intake, serum concentrations and urinary excretion of manganese by adult males. Am J Clin Nutr 1990; 51: 457–461.CrossRefGoogle ScholarPubMed
18.Greenberg, DM, Copp, DH, Cuthberston, EM.Studies in mineral metabolism with aid of artificial radioactive isotopes; distribution and excretion particularly by way of bile, of iron, cobalt and manganese. J Biol Chem 1943; 147: 749–756.CrossRefGoogle Scholar
19.Pollack, S, George, JN, Reba, RC, Kaufmann, RM, Crosby, WH.The absorption of nonferrous metals in iron deficiency. J Clin Invest 1965; 44: 1470–1473.CrossRefGoogle ScholarPubMed
20.Klaassen, CD.Billiary excretion of manganese in rats, rabbits and dogs. Toxicol Appl Pharmacol 1974; 29: 458–468.CrossRefGoogle Scholar
21.Papavasiliou, PS, Miller, ST, Cotzias, GC.Role of liver in regulating distribution and excretion of manganese. Am J Physiol 1966; 211:211–216.CrossRefGoogle ScholarPubMed
22.Marchal, G, Ni, Y, Zhang, X, et al. Mn-DPDP enhanced MRI in experimental bile duct obstruction. J Comput Assist Tomography 1993; 17:290–296.CrossRefGoogle ScholarPubMed
23.Olanow, CW, Calne, DB, Chu, NS, Perl, D.Manganese-induced neurotoxicity. In: Calne, DBet al., eds. Advances in Neurodegeneration II, Birkhauser Press, 1994: 53–62.Google Scholar
24.Olanow, CW, Good, PF, Shinotoh, H, et al. Manganese intoxication in the rhesus monkey; a clinical, pathological, and biochemical study. Neurology (In Press).Google Scholar
25.Mirowitz, SA, Westrich, JJ, Hisch, JD.Hyperintense basal ganglia on Tl-weighted MR images in patients receiving parenteral nutrition. Radiology 1991; 181: 117–120.CrossRefGoogle Scholar
26.Nelson, K, Golnick, J, Korn, T, Angle, C.Manganese encephalopathy: utility of early magnetic resonance imaging Br J Indust Med 1993; 50:510–513.Google ScholarPubMed
27.Mirowitz, SA, Westrich, TJ.Basal ganglia signal intensity alternations: reversal after discontinuation of parenteral manganese administration. Radiology 1992; 185: 535–536.CrossRefGoogle Scholar
28.Watanabe, A, Murakami, J, Ando, T, et al. Reduction of increased signal intensity in the basal ganglia on Tl-weighted MR images during treatment of hepatic encephalopathy. Internal Med 1993; 32: 10–14.CrossRefGoogle Scholar
29.Mena, I, Marin, O, Fuenzalida, S, Cotzias, GC.Chronic manganese poisoning: clinical picture and manganese turnover. Neurology 1967; 17: 128–136.CrossRefGoogle ScholarPubMed
30.Huang, CC, Chu, NS, Lu, CS, et al. Chronic manganese intoxication. Arch Neurol 1989; 46: 1104–1106.CrossRefGoogle ScholarPubMed
31.Cook, DG, Fahn, S, Brait, KA.Chronic manganese intoxication. Arch Neurol 1974; 30:59–64.CrossRefGoogle ScholarPubMed
32.Huang, CC, Lu, CS, Chu, NS, et al. Progression after chronic manganese exposure. Neurology 1993; 43: 1479–1483.CrossRefGoogle ScholarPubMed
33.Calne, DB, Chu, NS, Hung, CC, Lu, CS, Olanow, CW.Manganism and idiopathic parkinsonism: similarities and differences. Neurology 1994; 44: 1583–1586.CrossRefGoogle ScholarPubMed
34.Sherlock, S, Summerskill, WHJ, White, LP, Phear, EA.Portal-systemic encephalopathy: neurological complications of liver disease. Lancet 1954; 267: 453–457.CrossRefGoogle ScholarPubMed
35.Victor, M, Adams, RD, Cole, M.The acquired (non-Wilsonian) type of chronic hepatocerebral degeneration. Medicine 1965; 44: 345–396.CrossRefGoogle ScholarPubMed
36.Read, AE, Sherlock, S, Laidlaw, J, Walker, JG.The neuro-psychiatric syndromes associated with chronic liver disease and an extensive postal-systemic collateral circulation. Quart J Med 1967; 36: 135–150.Google Scholar
37.Barron, TF, Deveny, AG, Mamourian, AC.Symptomatic manganese neurotoxicity in a patient with chronic liver disease: correlation of clinical symptoms with MRI findings. Ped Neurol 1994; 10: 145–148.CrossRefGoogle Scholar