Hyperintense basal ganglia on T1-weighted MR images in patients receiving parenteral nutrition.

Abstract

Patterns of intracranial signal intensity on magnetic resonance (MR) images were studied in nine patients undergoing long-term total parenteral nutrition therapy. The duration of therapy ranged from 5 months to 11 years (mean, 5.3 years). Symmetric increased signal intensity on T1-weighted MR images (hyperintense relative to white matter) was observed in the basal ganglia of all patients, without corresponding abnormality on T2-weighted images. Analysis of signal-intensity characteristics and distribution pattern suggests that the basis for these changes may be deposition of intravenously administered paramagnetic trace elements, especially manganese, and/or an astrogliotic reaction to such deposition.

Neuroimaging in Manganese-Induced Parkinsonism

“…Nelson et al (1993) were the first to report increased signal intensities in a patient with occupational Mn neurointoxication. A similar MRI pattern has also been observed in patients receiving total parenteral nutrition (TPN) by direct intravenous administration (Ejima et al, 1992;Mirowitz et al, 1991) and in patients with portal systemic shunts such as individuals with liver cirrhosis, leading to an inability to clear Mn via biliary excretion (Butterworth et al, 1995;Hauser et al, 1994Hauser et al, , 1996Krieger et al, 1995;Park et al, 2003;Spahr et al, 1996). A high pallidal signal is very frequently observed in patients with established liver cirrhosis, but who lack exposure to Mn .…”

“…The cited authors found that the increased signal intensities resolved significantly approximately 1 year after Mn exposure ceased (Kim et al, 1999b). The disappearance of high signal abnormalities on MRI following withdrawal of the Mn source has been shown after the cessation of occupational exposure (Nelson et al, 1993), after discontinuation of TPN (Mirowitz et al, 1991), and after liver transplantation in patients with hepatic failure Pujol et al, 1993). These findings suggest that increased signal intensities on a T1-weighted image reflect exposure to Mn, but do not necessarily indicate the presence of manganism.…”

Brain magnetic resonance imaging and manganese concentrations in red blood cells of smelting workers: Search for biomarkers of manganese exposure

“…The enhanced T1-weighted MRI signals have been observed in patients receiving total parenteral nutrition, presumably owing to excessive Mn intake (Mirowitz et al, 1991;Mirowitz and Westrich, 1992), and in patients with liver failure because of their inability to eliminate Mn (Krieger et al, 1995). Appreciably, these patients usually do not have permanent neurological damage.…”

Contribution of metals to brain MR signal intensity: review articles

“…Regardless of the administration route of MnCl 2 , an increasing signal intensity on MRI is observed in the caudate nucleus, globus pallidus, substantia nigra, ventromedial hypothalamus, and pituitary gland [23]. Even in man, a hyperintense globus pallidus was found in patients receiving long-term total parenteral nutrition therapy that included manganese [24] and in workers exposed to manganese [25][26][27], with these hyperintensities diminishing after cessation of the manganese exposure [25,28,29]. Intravenous administration or inhalation of manganese causes manganese deposition in the brain, but the oral intake of manganese rarely results in manganese deposition.…”