AN INVIVO P-31 MRS STUDY OF PATIENTS WITH LIVER-CIRRHOSIS - PROGRESS TOWARDS A NONINVASIVE ASSESSMENT OF DISEASE SEVERITY

Fourteen patients with liver cirrhosis of differing severity participa ted in a one-dimensional chemical shift imaging P-31 MRS study of the liver. Patients were divided into two groups according to the severity of their liver disease using Child's classification and the aminopyri ne breath test (AB test). Seven normal volunteers without liver diseas e acted as controls. The phosphomonester (PME) peak in normal subjects was 4.77% (95% confidence interval, CI: 4.11-5.42) of total phosphoru s. The PME peak was significantly elevated in both mild cirrhosis [5.8 0% (95% CI: 5.46-6.14), p=0.0051, vs normal subjects] and severe cirrh osis (9.64% (95% CI: 8.71-10.57), p=0.0002, vs normal subjects and p = 0.001, vs mild cirrhosis]. There was a significant negative linear co rrelation (r=0.88, p<0.01) of PME with the percentage dose of (CO2)-C- 14 excreted over 2 h in the AB test. pH values in patients with mild c irrhosis [7.45 (95% CI: 7.35-7.55)] but not severe cirrhosis [7.36 (95 % CI: 7.25-7.47)] were significantly elevated (p=0.04) compared to nor mal subjects [7.29 (95% CI: 7.17-7.41)]. Comparison of the peak area o f PME at TR=0.5 s against that using TR=5.0 s in cirrhotic liver sugge sted no reduction in T1 of phosphorus metabolites in cirrhosis. A rela tionship between the severity of liver cirrhosis and a relative increa se in PME was demonstrated and this was not due to a reduction of T1. This study highlights the clinical potential of P-31 MRS as a non-inva sive means of assessing the severity of liver cirrhosis.