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Quantitative 31P magnetic resonance spectroscopy in diffuse liver disease
Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
2006 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

The studies in this thesis were delineated to evaluate the diagnostic possibilities in patients with diffuse liver disease by using phosphorus-31 MR spectroscopy and comparing the results with clinical, laboratory and histopathological findings. For this purpose in all 38 patients and 25 controls without evidence of liver disease were examined.

In the first study 31P-MRS using slice selection (DRESS) was implemented to investigate the absolute concentrations of metabolites in human liver. The metabolite concentration quantification procedures included: 1. Determination of optimal depth for the in vivo measurements, 2. Mapping the detection coil characteristics, 3. Calculation of selected slice and liver volume ratios using simple segmentation procedures, and 4. Spectral analysis in the time domain. Patients with histopathologically proven diffuse liver disease (n = 9) and healthy individuals (n = 12) were examined. The patients had significantly lower concentrations of phosphodiesters (PDE) and ATP-ß compared with the control group. Constructing an anabolic charge (AC) based on absolute concentrations, [PME] / ([PME] + [PDE]), the patients had a significant larger AC than the control subjects, 0.29 vs. 0.16 (p < 0.005).

In the second study the MRS technique was applied on two distinct groups of patients with diffuse chronic liver disorders, one group with steatosis and none-to-moderate inflammation (n = 13) and one group with severe fibrosis or cirrhosis (n = 16). All patients underwent liver biopsy and extensive biochemical evaluation. A control group (n = 13) was also included. Lower concentrations of PDE (p = 0.025) and a higher AC (p = 0.001) were found in the cirrhosis group compared to the control group.

Using a PDE concentration of 10.5 mM as a cut-off value to discriminate between mild (stage 0-2) and advanced (stage 3-4) fibrosis the sensitivity and specificity were 81% and 69% respectively. An AC cut-off value of 0.27 showed a sensitivity of 93% and a specificity of 54%.

In conclusion the results indicates that a decrease in PDE concentration is a marker of liver fibrosis and that AC is a potentially clinically useful parameter indiscriminating mild fibrosis from advanced. No significant relationship between the MRS data and the degree of steatosis or inflammation was found.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2006. , 41 p.
Series
Linköping Studies in Health Sciences. Thesis, ISSN 1100-6013 ; 77
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-34266Local ID: 21190ISBN: 91-85497-88-6 (print)OAI: oai:DiVA.org:liu-34266DiVA: diva2:255114
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2013-09-18
List of papers
1. Absolute quantification of human liver metabolite concentrations by localized in vivo 31P NMR spectroscopy in diffuse liver disease
Open this publication in new window or tab >>Absolute quantification of human liver metabolite concentrations by localized in vivo 31P NMR spectroscopy in diffuse liver disease
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2005 (English)In: European Radiology, ISSN 0938-7994, E-ISSN 1432-1084, Vol. 15, no 1, 148-157 p.Article in journal (Refereed) Published
Abstract [en]

Phosphorus-31 NMR spectroscopy using slice selection (DRESS) was used to investigate the absolute concentrations of metabolites in the human liver. Absolute concentrations provide more specific biochemical information compared to spectrum integral ratios. Nine patients with histopathologically proven diffuse liver disease and 12 healthy individuals were examined in a 1.5-T MR scanner (GE Signa LX Echospeed plus). The metabolite concentration quantification procedures included: (1) determination of optimal depth for the in vivo measurements, (2) mapping the detection coil characteristics, (3) calculation of selected slice and liver volume ratios using simple segmentation procedures and (4) spectral analysis in the time domain. The patients had significantly lower concentrations of phosphodiesters (PDE), 6.3±3.9 mM, and ATP-β, 3.6±1.1 mM, (P<0.05) compared with the control group (10.0±4.2 mM and 4.2±0.3 mM, respectively). The concentrations of phosphomonoesters (PME) were higher in the patient group, although this was not significant. Constructing an anabolic charge (AC) based on absolute concentrations, [PME]/([PME] + [PDE]), the patients had a significantly larger AC than the control subjects, 0.29 vs. 0.16 (P<0.005). Absolute concentration measurements of phosphorus metabolites in the liver are feasible using a slice selective sequence, and the technique demonstrates significant differences between patients and healthy subjects.

Keyword
phosphorus MR spectroscopy, absolute concentrations, diffuse liver disease
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-24421 (URN)10.1007/s00330-004-2434-x (DOI)000227354900022 ()6524 (Local ID)6524 (Archive number)6524 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13
2. Separation of advanced from mild fibrosis in diffuse liver disease using 31P magnetic resonance spectroscopy
Open this publication in new window or tab >>Separation of advanced from mild fibrosis in diffuse liver disease using 31P magnetic resonance spectroscopy
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2008 (English)In: European Journal of Radiology, ISSN 0720-048X, E-ISSN 1872-7727, Vol. 66, no 2, 313-320 p.Article in journal (Refereed) Published
Abstract [en]

31P-MRS using DRESS was used to compare absolute liver metabolite concentrations (PME, Pi, PDE, γATP, αATP, βATP) in two distinct groups of patients with chronic diffuse liver disorders, one group with steatosis (NAFLD) and none to moderate inflammation (n = 13), and one group with severe fibrosis or cirrhosis (n = 16). All patients underwent liver biopsy and extensive biochemical evaluation. A control group (n = 13) was also included. Absolute concentrations and the anabolic charge, AC = {PME}/({PME} + {PDE}), were calculated.

Comparing the control and cirrhosis groups, lower concentrations of PDE (p = 0.025) and a higher AC (p < 0.001) were found in the cirrhosis group. Also compared to the NAFLD group, the cirrhosis group had lower concentrations of PDE (p = 0.01) and a higher AC (p = 0.009). No significant differences were found between the control and NAFLD group. When the MRS findings were related to the fibrosis stage obtained at biopsy, there were significant differences in PDE between stage F0–1 and stage F4 and in AC between stage F0–1 and stage F2–3.

Using a PDE concentration of 10.5 mM as a cut-off value to discriminate between mild, F0–2, and advanced, F3–4, fibrosis the sensitivity and specificity were 81% and 69%, respectively. An AC cut-off value of 0.27 showed a sensitivity of 93% and a specificity of 54%.

In conclusion, the results suggest that PDE is a marker of liver fibrosis, and that AC is a potentially clinically useful parameter in discriminating mild fibrosis from advanced.

Place, publisher, year, edition, pages
Elsevier, 2008
Keyword
Absolute quantification; Phosphorus; MRS; Steatosis; In vivo
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-43125 (URN)10.1016/j.ejrad.2007.06.004 (DOI)000256140900026 ()17646074 (PubMedID)71944 (Local ID)71944 (Archive number)71944 (OAI)
Projects
NILB
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13Bibliographically approved

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