Etiology and functional status of liver cirrhosis by 31P MR spectroscopy

AIM: To assess the functional status and etiology of liver cirrhosis by quantitative 31P magnetic resonance spectroscopy (MRS). METHODS: A total of 80 patients with liver cirrhosis of different etiology and functional status described by Child-Pugh score were examined and compared to 11 healthy volunteers. MR examination was performed on a 1.5 T imager using a 1H/31P surface coil by the 2D chemical shift imaging technique. Absolute concentrations of phosphomonoesters (PME), phosphodiesters (PDE), inorganic phosphate (Pi) and adenosine triphosphate (ATP) were measured. RESULTS: MRS changes reflected the degree of liver dysfunction in all the patients as well as in individual etiological groups. The most important change was a decrease of PDE. It was possible to distinguish alcoholic, viral and cholestatic etiologies based on MR spectra. Alcoholic and viral etiology differed in PDE (alcoholic, viral, controls: 6.5±2.3, 6.5±3.1, 10.8±2.7 mmol/L, P<0.001) and ATP (alcoholic, viral, controls: 2.9±0.8, 2.8 ±0.9, 3.7±1.0 mmol/L, P<0.01) from the control group. Unlike viral etiology, patients with alcoholic etiology also differed in Pi (alcoholic, controls: 1.2±0.4, 1.6±0.6 mmol/L, P<0.05) from controls. No significant changes were found in patients with cholestatic disease and controls; nevertheless, this group differed from both alcoholic and viral groups (cholestatic, alcoholic, viral: 9.4 ±2.7, 6.5±2.3, 6.5±3.1 mmol/L, P<0.005) in PDE. CONCLUSION: 31P MRS can significantly help in non-invasive separation of different etiological groups leading to liver cirrhosis. In addition, MRS changes reflect functional liver injury.