Objective: To investigate the correlations between 31P-magnetic resonance spectroscopy (MRS) findings and histopathological grading and staging of the livers of chronic viral hepatitis patients.
Methods: Thirty-one patients with chronic viral hepatitis and 18 healthy volunteers were enrolled for this study. All of them underwent routine MRI plain scan and 31P-MRS of their livers. Peak areas of PME, PDE, PCr, Pi, gamma-ATP, beta-ATP and alpha-ATP were calculated. The concentrations of the phosphorus compounds of their livers, including PME, PDE, PCr, Pi, gamma-ATP, beta-ATP and alpha-ATP were measured. Percutaneous liver biopsies were performed on all 31 patients 0 to 7 days after their 31P-MRS examinations. Biopsy specimens were scored for fibrosis and necroinflammation according to the Knodell histological activity index. According to their necroinflammation scores, the 31 patients were divided into groups: slight hepatitis (7 patients), mild hepatitis (11), moderate hepatitis (8) and severe hepatitis (5). According to their fibrosis scores, the patients were divided into groups: no fibrosis (7 patients), portal fibrosis (11), bridging fibrosis (5) and cirrhosis (8).
Results: The PME%, PDE% and PME/PDE of the hepatitis patients and of the control volunteers had significant statistical differences. The differences of PME%, PDE% and PME/PDE among different grades and stages also had statistical significance. When PME/PDE=0.78, 0.95 and 1.11 were set as the cut-off points for different grades of necroinflammation, and PME/PDE=0.79, 0.95 and 1.10 were set as the cut-off points for different stages of fibrosis, a sensitivity of 80.0%-87.5% and a specificity of 42.9%-72.7% were achieved.
Conclusion: PME/PDE is a sensitive marker for diagnosing the severity of chronic viral hepatitis. A rise of PME/PDE in hepatitis patients represents an increase of synthesis and a decrease in the breakdown of hepatocytes.