Munakata T, Griffiths R D, Martin P A, Jenkins S A, Shields R, Edwards R H
Magnetic Resonance Research Centre, University of Liverpool, UK.
NMR Biomed. 1993 Mar-Apr;6(2):168-72. doi: 10.1002/nbm.1940060211.
Fourteen patients with liver cirrhosis of differing severity participated in a one-dimensional chemical shift imaging 31P MRS study of the liver. Patients were divided into two groups according to the severity of their liver disease using Child's classification and the aminopyrine breath test (AB test). Seven normal volunteers without liver disease acted as controls. The phosphomonester (PME) peak in normal subjects was 4.77% (95% confidence interval, CI: 4.11-5.42) of total phosphorus. The PME peak was significantly elevated in both mild cirrhosis [5.80% (95% CI: 5.46-6.14), p = 0.0051, vs normal subjects] and severe cirrhosis [9.64% (95% CI: 8.71-10.57), p = 0.0002, vs normal subjects and p = 0.001, vs mild cirrhosis]. There was a significant negative linear correlation (r = 0.88, p < 0.01) of PME with the percentage dose of 14CO2 excreted over 2 h in the AB test. pH values in patients with mild cirrhosis [7.45 (95% CI: 7.35-7.55)] but not severe cirrhosis [7.36 (95% CI: 7.25-7.47)] were significantly elevated (p = 0.04) compared to normal subjects [7.29 (95% CI: 7.17-7.41)]. Comparison of the peak area of PME at TR = 0.5 s against that using TR = 5.0 s in cirrhotic liver suggested no reduction in T1 of phosphorus metabolites in cirrhosis. A relationship between the severity of liver cirrhosis and a relative increase in PME was demonstrated and this was not due to a reduction of T1. This study highlights the clinical potential of 31P MRS as a non-invasive means of assessing the severity of liver cirrhosis.
14例不同严重程度的肝硬化患者参与了肝脏的一维化学位移成像31P磁共振波谱研究。根据Child分级和氨基比林呼吸试验（AB试验），将患者按肝病严重程度分为两组。7名无肝病的正常志愿者作为对照。正常受试者的磷酸单酯（PME）峰占总磷的4.77%（95%置信区间，CI：4.11 - 5.42）。轻度肝硬化患者的PME峰[5.80%（95%CI：5.46 - 6.14），与正常受试者相比，p = 0.0051]和重度肝硬化患者的PME峰[9.64%（95%CI：8.71 - 10.57），与正常受试者相比，p = 0.0002，与轻度肝硬化相比，p = 0.001]均显著升高。在AB试验中，PME与2小时内呼出的14CO2百分比剂量呈显著负线性相关（r = 0.88，p < 0.01）。与正常受试者[7.29（95%CI：7.17 - 7.41）]相比，轻度肝硬化患者的pH值[7.45（95%CI：7.35 - 7.55）]显著升高（p = 0.04），而重度肝硬化患者的pH值[7.36（95%CI：7.25 - 7.47）]则未显著升高。在肝硬化肝脏中，比较TR = 0.5 s时与TR = 5.0 s时PME的峰面积，提示肝硬化时磷代谢物的T1未降低。研究表明肝硬化严重程度与PME相对增加之间存在关联，且这并非由于T1降低所致。本研究突出了31P磁共振波谱作为评估肝硬化严重程度的非侵入性手段的临床潜力。
