Lim, A.K.P.; Patel, N.; Hamilton, G.; Hajnal, J.V.; Goldin, R.; Taylor-Robinson, S.D.
April 2003
Gut;Apr2003 Supplement 1, Vol. 52, pA3
Academic Journal
Purpose: Liver biopsy remains the gold standard for characterising and staging diffuse liver disease. This invasive test is associated with significant morbidity and, rarely, mortality. Our aim was to investigate whether a non-invasive technique, in vivo [sup 31]P-(MRS) could grade the severity of diffuse liver disease in patients whose liver disease was attributable to hepatitis C (HCV) infection only. Materials and Methods: Twelve controls and 47 patients with biopsy-proven HCV infection were studied prospectively. Based on their histological fibrosis (F) and necroinflammatory (NI) scores, patients were divided into mild hepatitis, n = 17 (F 2/6, NI 3/18); moderate/severe hepatitis, n = 19 (F 3/6, NI 4/18); and cirrhosis, n = 11 (F = 6). Hepatic [sup 31]P MR spectra were obtained using a 1.5 Tesla spectroscopy system (TR: 10 000; TE: 2). Results: There was a monotonic increase in the mean ± 1 s.e. phosphomonoester (PME) to phosphodiester (PDE) ratios for the control, mild hepatitis, moderate hepatitis and cirrhosis groups: 0.16 ± 0.01, 0.19 ± 0.07, 0.25 ± 0.02, 0.38 ± 0.04, respectively (ANOVA p < 0.001). No other significant spectral changes were observed. Conclusion: [sup 31]P MRS cannot diagnose HCV infection, but in patients with proven infection, this test can characterise the severity of liver disease. We have shown that the ratio of PME to PDE resonance in [sup 31]P MRS is able to separate mild from moderate hepatitis and these two groups from cirrhosis. The ability to differentiate these populations of patients has therapeutic implications and [sup 31]P MRS, in some situations, would not only complement a liver biopsy but could replace.


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