Serial evaluation of children with ALF with advanced MRI, serum proinflammatory cytokines, thiamine, and cognition assessment

Anshu Srivastava, Santosh K. Yadav, Vibhor V. Borkar, Abhishek Yadav, Surender K. Yachha, Michael A. Thomas, Ram K.S. Rathore, Chandra M. Pandey, Rakesh K. Gupta

Research output: Contribution to journalArticle

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OBJECTIVES: This prospective, sequential study was done to understand changes in cerebral edema (CE) on magnetic resonance imaging and magnetic resonance spectroscopy, liver functions, and neurocognitive testing (NCT) in children with acute liver failure (ALF). METHODS: A total of 11 ALF and 8 healthy controls were evaluated with advanced magnetic resonance (MR) imaging, blood proinflammatory cytokines (PCs), thiamine levels, liver functions, and NCT. Reevaluation was done at 43.5 ± 26.9 days (first follow-up, n = 8) and 157.3 ± 52.3 days (second follow-up, n = 6) after discharge. RESULTS: At diagnosis, patients with ALF had vasogenic and cytotoxic CE, raised brain glutamine (23.2 ± 3.4 vs 15.3 ± 2.7), and serum PCs (tumor necrosis factor [TNF]-α 40.1 ± 8.9 vs 7.2 ± 2.7 pg/mL, interleukin [IL]-6 29.2 ± 14.4 vs 4.7 ± 1.2 pg/mL). The mammillary bodies (MBs) were smaller, and brain choline (1.9 ± 0.36 vs 2.6 ± 0.6) and blood thiamine (55.2 ± 6.7 vs 81.8 ± 10.2 nmol/L) were lower than controls. At first follow-up, the brain glutamine and CE recovered. Brain choline and MBs volume showed improvement and thiamine levels normalized. Significant reduction in TNF-α and IL-6 was seen. The patients performed poorly on NCT, which normalized at second follow-up. Liver biochemistry and thiamine levels were normal and TNF-α and IL-6 showed further reduction at second follow-up. CONCLUSIONS: Patients with ALF have CE contributed by raised brain glutamine and PCs. MBs are small because of thiamine deficiency and show recovery in follow-up. CE and brain glutamine recover earlier than normalization of NCT and liver functions. Persistence of raised cytokines up to 6 months after insult suggests possible contribution from liver regeneration.

Original languageEnglish
Pages (from-to)580-586
Number of pages7
JournalJournal of Pediatric Gastroenterology and Nutrition
Issue number5
Publication statusPublished - 1 Nov 2012



  • Acute liver failure
  • Cerebral edema
  • Diffusion tensor imaging
  • H-MR spectroscopy
  • Neuropsychological tests
  • Proinflammatory cytokines
  • Thiamine

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Gastroenterology

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