title: Separation of advanced from mild fibrosis in diffuse liver disease using 31P magnetic resonance spectroscopy.
abstract: 31P-MRS using DRESS was used to compare absolute liver metabolite concentrations (PME, Pi, PDE, gammaATP, alphaATP, betaATP) in two distinct groups of patients with chronic diffuse liver disorders, one group with steatosis (NAFLD) and none to moderate inflammation (n=13), and one group with severe fibrosis or cirrhosis (n=16). All patients underwent liver biopsy and extensive biochemical evaluation. A control group (n=13) was also included. Absolute concentrations and the anabolic charge, AC=[PME]/([PME]+[PDE]), were calculated. Comparing the control and cirrhosis groups, lower concentrations of PDE (p=0.025) and a higher AC (p<0.001) were found in the cirrhosis group. Also compared to the NAFLD group, the cirrhosis group had lower concentrations of PDE (p=0.01) and a higher AC (p=0.009). No significant differences were found between the control and NAFLD group. When the MRS findings were related to the fibrosis stage obtained at biopsy, there were significant differences in PDE between stage F0-1 and stage F4 and in AC between stage F0-1 and stage F2-3. Using a PDE concentration of 10.5mM as a cut-off value to discriminate between mild, F0-2, and advanced, F3-4, fibrosis the sensitivity and specificity were 81% and 69%, respectively. An AC cut-off value of 0.27 showed a sensitivity of 93% and a specificity of 54%. In conclusion, the results suggest that PDE is a marker of liver fibrosis, and that AC is a potentially clinically useful parameter in discriminating mild fibrosis from advanced.
authors.affiliation: Department of Radiology, Linköping University, SE-581 85 Linköping, Sweden.
authors.forename: Bengt
authors.initials: B
authors.lastname: Noren
authors.forename: Olof
authors.initials: O
authors.lastname: Dahlqvist
authors.forename: Peter
authors.initials: P
authors.lastname: Lundberg
authors.forename: Sven
authors.initials: S
authors.lastname: Almer
authors.forename: Stergios
authors.initials: S
authors.lastname: Kechagias
authors.forename: Mattias
authors.initials: M
authors.lastname: Ekstedt
authors.forename: Lennart
authors.initials: L
authors.lastname: Franzén
authors.forename: Staffan
authors.initials: S
authors.lastname: Wirell
authors.forename: Orjan
authors.initials: O
authors.lastname: Smedby
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003937:Diagnosis, Differential; D005234:Fatty Liver / Q000378:metabolism / Q000473:pathology; D005260:Female; D006801:Humans; D008099:Liver / Q000378:metabolism / Q000473:pathology; D008103:Liver Cirrhosis / Q000378:metabolism / Q000473:pathology*; D008111:Liver Function Tests; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010759:Phosphorus Isotopes; D012680:Sensitivity and Specificity; D012815:Signal Processing, Computer-Assisted; D018709:Statistics, Nonparametric
chemical_list: D010759:Phosphorus Isotopes