High signal intensities on T1-weighted MRI as a biomarker of exposure to manganese.

Increased signal in T1-weighted images was observed in the experimental manganese (Mn) poisoning of the non-human primate and a patient with Mn neurointoxication. However, our study showed that the increased signals in magnetic resonance images (MRI) were highly prevalent (41.6%) in Mn-exposed workers. Especially 73.5% of the welders showed increased signal intensities. Blood Mn concentration correlated with pallidal index. These changes in MRI tend to disappear following the withdrawal from the source of Mn accumulation, despite permanent neurological damage. Thus increased signal intensities on a T1-weighted image reflect exposure to Mn, but not necessarily manganism. Our study also showed that the concentration of Mn required to produce increased signal intensities on MRI is much lower than the threshold necessary to result in overt clinical signs of manganism. Increased signal intensities in the globus pallidus were determined by Mn accumulation in the animal experiment. All these results strongly suggest that signal intensities in T1-weighted MRI reflect a target site dose in a biologically-based dose-response model. At which increase of signal intensity, the progression of manganism from Mn exposure occurs, however, remains to be solved.