title: Proton and phosphorus-31 nuclear magnetic resonance spectroscopy of human bile in hepatopancreaticobiliary cancer.
abstract: OBJECTIVE
  Hepatopancreaticobiliary cancers can be difficult to diagnose. Nuclear magnetic resonance (NMR) spectroscopy provides non-invasive information on phospholipid metabolism, and previous studies of liver tissue have highlighted changes in phospholipids in malignancy. We hypothesised that in-vitro NMR spectroscopy of human bile may provide independent diagnostic indices in cancer management through an assessment of the phospholipid content.
  
  
  METHODS
  Bile samples from 24 patients were collected at endoscopic retrograde cholangiopancreatography and from one subject at cholecystectomy. Thirteen patients had cancer: pancreatic carcinoma (eight), cholangiocarcinoma (three) and metastatic liver disease (two). The remaining 12 patients had non-malignant pathology. In-vitro proton (H) and phosphorus-31 (P) NMR spectra were obtained from all samples using an 11.7 Tesla NMR spectroscopy system.
  
  
  RESULTS
  Complementary information was obtained from the H and P NMR spectra. Signals were assigned to phosphatidylcholine in both H and P NMR spectra. Phosphatidylcholine levels were significantly reduced in the bile from cancer patients when compared with bile from non-cancer patients (P=0.007).
  
  
  CONCLUSIONS
  These preliminary studies suggest that H and P NMR spectroscopy of bile may be used to detect differences in phospholipid content between cancer and non-cancer patients. This may have implications for the development of novel diagnostic strategies in hepatopancreaticobiliary cancers. Further larger-scale studies are warranted.
authors.affiliation: Liver Unit, Division of Medicine, St Mary's Hospital Campus, Imperial College London, London, UK. shahid.khan@imperial.ac.uk
authors.forename: Shahid A
authors.initials: SA
authors.lastname: Khan
authors.forename: I Jane
authors.initials: IJ
authors.lastname: Cox
authors.forename: Andrew V
authors.initials: AV
authors.lastname: Thillainayagam
authors.forename: Devinder S
authors.initials: DS
authors.lastname: Bansi
authors.forename: Howard C
authors.initials: HC
authors.lastname: Thomas
authors.forename: Simon D
authors.initials: SD
authors.lastname: Taylor-Robinson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001646:Bile / Q000737:chemistry*; D001650:Bile Duct Neoplasms / Q000737:chemistry* / Q000000981:diagnostic imaging / Q000601:surgery; D001653:Bile Ducts, Intrahepatic / Q000737:chemistry / Q000000981:diagnostic imaging / Q000601:surgery; D018281:Cholangiocarcinoma / Q000737:chemistry / Q000000981:diagnostic imaging / Q000601:surgery; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000379:methods; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000737:chemistry* / Q000000981:diagnostic imaging / Q000601:surgery; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000737:chemistry* / Q000000981:diagnostic imaging / Q000601:surgery; D010743:Phospholipids / Q000032:analysis; D010759:Phosphorus Isotopes; D010865:Pilot Projects; D011522:Protons
chemical_list: D010743:Phospholipids; D010759:Phosphorus Isotopes; D011522:Protons