IN-VIVO AND IN-VITRO HEPATIC P-31 MAGNETIC-RESONANCE SPECTROSCOPY ANDELECTRON-MICROSCOPY OF THE CIRRHOTIC LIVER

In vivo P-31 magnetic resonance spectroscopy(MRS) provides direct bioc hemical information on hepatic metabolic processes. To assess in vivo changes in hepatic P-31 MRS in liver transplant candidates, we studied 31 patients with cirrhosis of varying aetiology; 14 with compensated cirrhosis (Pugh's score less than or equal to 7) and 17 with decompens ated cirrhosis (Pugh's score greater than or equal to 8). Underlying c ellular abnormalities were characterised using in vitro P-31 MRS and e lectron microscopy. In vitro spectra were obtained from liver extracts , freeze-clamped at recipient hepatectomy, from all subjects. Electron microscopy of liver tissue was also performed in 17 cases. Relative t o nucleotide triphosphates, elevations in phosphomonoesters and reduct ions in phosphodiesters were observed in vivo with worsening liver fun ction. In vitro spectra showed elevated phosphoethanolamine and phosph ocholine, and reduced glycerophosphorylethanolamine and glycerophospho rylcholine, mirroring the in vivo changes, but no distinction was note d between compensated and decompensated cirrhosis. With electron micro scopy, functional decompensation was associated with reduced endoplasm ic reticulum in parenchymal liver disease, but elevated levels in bili ary cirrhosis. We conclude that in vivo spectral abnormalities in cirr hosis are consistent with alterations in phospholipid metabolism and q uantity of endoplasmic reticulum. However, in individual patients the biopsy results do not always mirror in vivo findings.