An in vivo³¹P MRS study of patients with liver cirrhosis: Progress towards a non‐invasive assessment of disease severity

Abstract

Fourteen patients with liver cirrhosis of differing severity participated in a one-dimensional chemical shift imaging 31P MRS study of the liver. Patients were divided into two groups according to the severity of their liver disease using Child's classification and the aminopyrine breath test (AB test). Seven normal volunteers without liver disease acted as controls. The phosphomonester (PME) peak in normal subjects was 4.77% (95% confidence interval, CI: 4.11-5.42) of total phosphorus. The PME peak was significantly elevated in both mild cirrhosis [5.80% (95% CI: 5.46-6.14), p = 0.0051, vs normal subjects] and severe cirrhosis [9.64% (95% CI: 8.71-10.57), p = 0.0002, vs normal subjects and p = 0.001, vs mild cirrhosis]. There was a significant negative linear correlation (r = 0.88, p < 0.01) of PME with the percentage dose of 14CO2 excreted over 2 h in the AB test. pH values in patients with mild cirrhosis [7.45 (95% CI: 7.35-7.55)] but not severe cirrhosis [7.36 (95% CI: 7.25-7.47)] were significantly elevated (p = 0.04) compared to normal subjects [7.29 (95% CI: 7.17-7.41)]. Comparison of the peak area of PME at TR = 0.5 s against that using TR = 5.0 s in cirrhotic liver suggested no reduction in T1 of phosphorus metabolites in cirrhosis. A relationship between the severity of liver cirrhosis and a relative increase in PME was demonstrated and this was not due to a reduction of T1. This study highlights the clinical potential of 31P MRS as a non-invasive means of assessing the severity of liver cirrhosis.

Magnetic resonance imaging of hepatic fibrosis: Emerging clinical applications

“…Among patients with established cirrhosis, an increased hepatic PME signal measured by MR spectroscopy has been reported. [48][49][50][51] The relationship between PDE and cirrhosis, however, is not well understood. 45 For patients with varying degrees of involvement with chronic hepatitis, an increasing PME/PDE ratio was found to correlate with necroinflammatory and fibrosis scores on liver histology compared with healthy volunteers.…”

The relationship of in vivo31P MR spectroscopy to histology in chronic hepatitis C

“…[7][8][9][10][11] Several previous studies have shown abnormalities in the PME resonance or PME/NTP, PME/PDE, and PDE/NTP ratios in patients with cirrhosis. [12][13][14][15][16] However, our study compared the spectral abnormalities in a cohort of patients with precirrhotic liver disease to assess the use of MRS in grading disease severity, compared with histology from liver biopsy. Our aims were to assess whether changes in in vivo 31 P MR spectra in patients with hepatitis C virus (HCV)-related liver disease correlated with histologic scores from liver biopsy and thus could provide an alternative noninvasive test for assessment of disease severity and a possible means for measuring the response of the liver to treatment intervention.…”

Chronic Hepatitis: In Vivo Proton MR Spectroscopic Evaluation of the Liver and Correlation with Histopathologic Findings

“…In many previously published studies (22)(23)(24)(25)(26), it has been reported that liver cirrhosis can be detected with phosphorous 31 MR spectroscopy. Study results have demonstrated that the normal liver and liver cirrhosis have different hydrogen 1 ( 1 H) MR spectroscopic features (27).…”