Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong.
Institute of Digestive Disease, The Chinese University of Hong Kong, Hong Kong; Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
J Hepatol. 2014 Apr;60(4):809-15. doi: 10.1016/j.jhep.2013.11.018. Epub 2013 Nov 26.
BACKGROUND & AIMS: Liver biopsy is the gold standard for diagnosing non-alcoholic fatty liver disease (NAFLD) but with practical constraints. Phosphorus magnetic resonance spectroscopy ((31)P-MRS) allows in vivo assessment of hepatocellular metabolism and has shown potential for biochemical differentiation in diffuse liver disease. Our aims were to describe spectroscopic signatures in biopsy-proven NAFLD and to determine diagnostic performance of (31)P-MRS for non-alcoholic steatohepatitis (NASH).
(31)P-MRS was performed in 151 subjects, comprised of healthy controls (n=19) and NAFLD patients with non-NASH (n=37) and NASH (n=95). Signal intensity ratios for phosphomonoesters (PME) including phosphoethanolamine (PE), phosphodiesters (PDE) including glycerophosphocholine (GPC), total nucleotide triphosphate (NTP) including α-NTP, and inorganic phosphate (Pi), expressed relative to total phosphate (TP) or [PME+PDE] and converted to percentage, were obtained.
Compared to controls, both NAFLD groups had increased PDE/TP (p<0.001) and decreased Pi/TP (p=0.011). Non-NASH patients showed decreased PE/[PME+PDE] (p=0.048), increased GPC/[PME+PDE] (p<0.001), and normal NTP/TP and α-NTP/TP. Whereas, NASH patients had normal PE/[PME+PDE] and GPC/[PME+PDE], but decreased NTP/TP (p=0.004) and α-NTP/TP (p<0.001). The latter was significantly different between non-NASH and NASH (p=0.047) and selected as discriminating parameter, with area under the receiver-operating characteristics curve of 0.71 (95% confidence interval, 0.62-0.79). An α-NTP/TP cutoff of 16.36% gave 91% sensitivity and cutoff of 10.57% gave 91% specificity for NASH.
(31)P-MRS shows distinct biochemical changes in different NAFLD states, and has fair diagnostic accuracy for NASH.
肝活检是诊断非酒精性脂肪性肝病（NAFLD）的金标准，但存在实际限制。磷磁共振波谱((31)P-MRS)可在体评估肝细胞代谢，并已显示出在弥漫性肝病中进行生化区分的潜力。我们的目的是描述经活检证实的 NAFLD 的光谱特征，并确定(31)P-MRS 对非酒精性脂肪性肝炎（NASH）的诊断性能。
对 151 名受试者进行(31)P-MRS 检查，包括健康对照组（n=19）和非 NASH（n=37）和 NASH（n=95）的 NAFLD 患者。获得磷酸单酯（PME）的信号强度比，包括磷酸乙醇胺（PE），磷酸二酯（PDE），包括甘油磷酸胆碱（GPC），三磷酸核苷（NTP），包括α-NTP，和无机磷（Pi），相对于总磷酸盐（TP）或[PME+PDE]表示，并转换为百分比。
与对照组相比，两组 NAFLD 患者的 PDE/TP 均升高（p<0.001），Pi/TP 降低（p=0.011）。非 NASH 患者的 PE/[PME+PDE]降低（p=0.048），GPC/[PME+PDE]升高（p<0.001），NTP/TP 和α-NTP/TP 正常。而 NASH 患者的 PE/[PME+PDE]和 GPC/[PME+PDE]正常，但 NTP/TP 降低（p=0.004）和α-NTP/TP 降低（p<0.001）。后者在非 NASH 和 NASH 之间有显著差异（p=0.047），并被选为鉴别参数，受试者工作特征曲线下面积为 0.71（95%置信区间，0.62-0.79）。α-NTP/TP 的截断值为 16.36%时，NASH 的敏感性为 91%，截断值为 10.57%时，特异性为 91%。
(31)P-MRS 显示不同 NAFLD 状态存在明显的生化变化，对 NASH 具有良好的诊断准确性。
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