Department of Internal Medicine III, Division of Endocrinology and Metabolism, Medical University of Vienna, Austria.
Eur J Radiol. 2010 Jun;74(3):e60-6. doi: 10.1016/j.ejrad.2009.03.062. Epub 2009 Apr 29.
Liver biopsy is the standard method for diagnosis of hepatic steatosis, but is invasive and carries some risk of morbidity.
Quantification of hepatocellular lipid content (HCL) with non-invasive single voxel (1)H magnetic resonance spectroscopy (MRS) at 3T was compared with histological grading and biochemical analysis of liver biopsies in 29 patients with chronic hepatitis C. Body mass index, indices of insulin resistance (homeostasis model assessment index, HOMA-IR), serum lipids and serum liver transaminases were also quantified.
HCL as assessed by (1)H MRS linearly correlated (r=0.70, p<0.001) with histological evaluation of liver biopsies and was in agreement with histological steatosis staging in 65% of the patients. Biochemically assessed hepatic triglyceride contents correlated with HCL measured with (1)H MRS (r=0.63, p<0.03) and allowed discriminating between none or mild steatosis versus moderate or severe steatosis. Patients infected with hepatitis C virus genotype 3 had a higher prevalence of steatosis (62%) which was not explained by differences in body mass or whole body insulin resistance. When these patients were excluded from correlation analysis, hepatic fat accumulation positively correlated with insulin resistance in the remaining hepatitis C patients (HCL vs. HOMA-IR, r=0.559, p<0.020, n=17).
Localized (1)H MRS is a valid and useful method for quantification of HCL content in patients with chronic hepatitis C and can be easily applied to non-invasively monitoring of steatosis during repeated follow-up measurements in a clinical setting.
肝活检是诊断肝脂肪变性的标准方法，但具有侵袭性且存在一定的发病风险。
在 3T 磁共振（MR）上对 29 例慢性丙型肝炎患者进行单容积（1）H 磁共振波谱（MRS）非侵入性检测肝细胞内脂肪含量（HCL），并与肝活检组织学分级和生化分析进行比较。还对体重指数、胰岛素抵抗指数（稳态模型评估指数，HOMA-IR）、血清脂质和血清肝转氨酶进行了定量分析。
（1）H MRS 评估的 HCL 与肝活检组织学评估呈线性相关（r=0.70，p<0.001），且与 65%的患者的肝脂肪变性分期一致。生化评估的肝甘油三酯含量与（1）H MRS 测量的 HCL 相关（r=0.63，p<0.03），可区分无或轻度脂肪变性与中度或重度脂肪变性。丙型肝炎病毒基因型 3 感染的患者脂肪变性发生率更高（62%），这不能用体重或全身胰岛素抵抗的差异来解释。当从相关性分析中排除这些患者时，在其余丙型肝炎患者中，肝脂肪堆积与胰岛素抵抗呈正相关（HCL 与 HOMA-IR，r=0.559，p<0.020，n=17）。
局部（1）H MRS 是一种定量检测慢性丙型肝炎患者 HCL 含量的有效且有用的方法，可在临床环境中轻松应用于非侵入性监测脂肪变性的重复随访测量。
