Hydrogen-1 MR spectroscopy for measurement and diagnosis of hepatic steatosis.
OBJECTIVE
Hydrogen-1 MR spectroscopy ((1)H-MRS) is gaining acceptance as a noninvasive technique for assessment of hepatic steatosis, and the findings have been found to correlate closely with histopathologic grade. The aims of this study were to validate (1)H-MRS performed with a 3-T MRI system for quantifying hepatic steatosis and to determine threshold values of (1)H-MRS proton density fat fraction corresponding to standard histopathologic grade in patients undergoing diagnostic liver biopsy.


METHODS
We conducted a prospective cross-sectional liver MRS study with 52 subjects undergoing diagnostic liver biopsy. The diagnostic accuracy of (1)H-MRS was evaluated with receiver operating characteristic curves.


RESULTS
The diagnostic accuracy of (1)H-MRS for hepatic steatosis was high with an area under the receiver operating characteristic curve of 0.94 (95% CI, 0.88-1.0). Results were similar for three (1)H-MRS measurements obtained at different locations in the liver, for two independent pathologists, and whether fibrosis was present or absent. One third of participants had elevated transaminase concentrations of unknown cause, and (1)H-MRS estimates of steatosis had perfect agreement with histopathologic grade in this group. Calculated (1)H-MRS proton density fat fraction thresholds for histologic grades were less than 17% for grade 0 or trace steatosis, 17-38.6% for grade 1, and greater than 38.6% for grade 2 or higher.


CONCLUSIONS
Hydrogen-1 MR spectroscopy is an effective, noninvasive technique that can be used to diagnose and quantify hepatic steatosis. Hydrogen-1 MR spectroscopy thresholds corresponded with histopathologic grades and may be useful in the workup of patients with elevated transaminase concentrations.
University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Patrick
P
Georgoff
David
D
Thomasson
Adeline
A
Louie
Estee
E
Fleischman
Lauren
L
Dutcher
Haresh
H
Mani
Shyamasundaran
S
Kottilil
Caryn
C
Morse
Lori
L
Dodd
David
D
Kleiner
Colleen
C
Hadigan
D019540:Area Under Curve; D001706:Biopsy; D003430:Cross-Sectional Studies; D005234:Fatty Liver / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology*; D005260:Female; D006801:Humans; D006859:Hydrogen; D008055:Lipids / Q000032:analysis*; D008099:Liver / Q000737:chemistry* / Q000378:metabolism*; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019047:Phantoms, Imaging; D011446:Prospective Studies; D012372:ROC Curve; D014280:Triglycerides / Q000032:analysis / Q000378:metabolism
D008055:Lipids; D014280:Triglycerides; D006859:Hydrogen