title: The relationship of in vivo 31P MR spectroscopy to histology in chronic hepatitis C.
abstract: Liver biopsy remains the gold standard for characterizing diffuse liver disease and is associated with significant morbidity and, rarely, mortality. Our aim was to investigate whether a noninvasive technique, in vivo phosphorus 31 ((31)P)-magnetic resonance spectroscopy (MRS), could be used to assess the severity of hepatitis C virus (HCV)-related liver disease. Fifteen healthy controls and 48 patients with biopsy-proven HCV-related liver disease were studied prospectively. Based on their histologic fibrosis (F) and necroinflammatory (NI) scores, patients were divided into mild hepatitis (F <or= 2/6, NI <or= 3/18), moderate/severe hepatitis (3 <or= F < 6 or NI >or= 4/18), and cirrhosis (F = 6/6). Hepatic (31)P MR spectra were obtained using a 1.5-T spectroscopy system. Quantitation of the (31)P signals was performed in the time domain using the Advanced MAgnetic RESonance algorithm. There was a monotonic increase in the mean +/- 1 standard error phosphomonoester (PME) to phosphodiester (PDE) ratios for the control, mild disease, moderate disease, and cirrhosis groups: 0.15 +/- 0.01, 0.18 +/- 0.02, 0.25 +/- 0.02, 0.38 +/- 0.04, respectively (ANOVA, P <.001). An 80% sensitivity and specificity was achieved when using a PME/PDE ratio less than or equal to 0.2 to denote mild hepatitis and a corresponding ratio greater than or equal to 0.3 to denote cirrhosis. No other significant spectral changes were observed. In conclusion, (31)P MRS can separate mild from moderate disease and these 2 groups from cirrhosis. The ability to differentiate these populations of patients has therapeutic implications and (31)P MRS, in some situations, would not only complement a liver biopsy but could replace it and be of particular value in assessing disease progression.
authors.affiliation: Robert Steiner MRI Unit, Medical Research Council Clinical Sciences Centre, Faculty of Medicine, Imperial College London, Hammersmith Hospital, London, UK. a.lim@ic.ac.uk
authors.forename: Adrian K P
authors.initials: AK
authors.lastname: Lim
authors.forename: Nayna
authors.initials: N
authors.lastname: Patel
authors.forename: Gavin
authors.initials: G
authors.lastname: Hamilton
authors.forename: Joseph V
authors.initials: JV
authors.lastname: Hajnal
authors.forename: Robert D
authors.initials: RD
authors.lastname: Goldin
authors.forename: Simon D
authors.initials: SD
authors.lastname: Taylor-Robinson
mesh_terms: D000328:Adult; D000465:Algorithms; D001706:Biopsy; D003937:Diagnosis, Differential; D004952:Esters / Q000378:metabolism; D005260:Female; D019698:Hepatitis C, Chronic / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D006801:Humans; D008099:Liver / Q000378:metabolism / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000378:metabolism; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D008875:Middle Aged; D010758:Phosphorus; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
chemical_list: D004952:Esters; D010758:Phosphorus