BLOOD MANGANESE CORRELATES WITH BRAIN MAGNETIC-RESONANCE-IMAGING CHANGES IN PATIENTS WITH LIVER-DISEASE

Background: Chronic liver failure is associated with high signal abnor malities in the basal ganglia on T1-weighted magnetic resonance imagin g of the brain. These abnormalities are strikingly similar to those se en following manganese intoxication, As dietary manganese is normally cleared by the liver, we hypothesize that hepatic dysfunction could le ad to manganese overload and account for the MRI abnormalities seen in patients with chronic liver disease. Methods: We measured blood manga nese concentrations in eleven patients with biopsy-proven hepatic cirr hosis and eleven healthy age and sex-matched controls, We also perform ed semi-quantitative measures of T1 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-qua ntitative scores of T1-weighted signal hyperintensity on MRI correlate d with blood manganese concentration in patients with cirrhosis (r = . 65, p = .029), Conclusions: These findings demonstrate that chronic li ver disease is associated with manganese overload and suggest that man ganese is responsible for the T1-weighted signal hyperintensity seen o n MRI of patients with liver disease, As manganese intoxication is kno wn to cause parkinsonism and an encephalopathy similar to those which occur with chronic liver disease, it is possible that manganese toxici ty contributes to the development of these symptoms in liver damaged p atients and that therapies which prevent or reduce manganese overload may have clinical benefit.