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

To assess the functional status and etiology of liver cirrhosis by quantitative (31)P magnetic resonance spectroscopy (MRS).

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 (1)H/(31)P 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.

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.

(31)P MRS can significantly help in non-invasive separation of different etiological groups leading to liver cirrhosis. In addition, MRS changes reflect functional liver injury.