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DOI: 10.1148/radiol.2261020517
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(Radiology 2003;226:288-289.)
© RSNA, 2003

Letters to the Editor

1H MR Spectroscopy in the Evaluation of the Severity of Chronic Liver Disease

Adrian K. P. Lim, FRCR, Gavin Hamilton, PhD, Nayna Patel, MSc, Jimmy D. Bell, PhD and Simon D. Taylor-Robinson, MD, FRCP

Robert Steiner MRI Unit, Imaging Sciences Department, Clinical Sciences Centre, Faculty of Medicine, Imperial College, Hammersmith Hospital Campus, Du Cane Road, London W12 0HS, England, e-mail: a.lim@ic.ac.uk

Editor:

We read with interest the article by Dr Cho and colleagues in the December issue of Radiology (1). We also have been investigating the utility of phosphorous 31 (31P) and hydrogen 1 (1H) magnetic resonance (MR) spectroscopy in the assessment of hepatic metabolic changes in patients with chronic liver disease (2–5).

We note that many other groups have reported about 1H MR spectroscopy as a research tool, but none have applied it to chronic liver disease. We were, therefore, pleased to note that Dr Cho and colleagues found 1H MR spectroscopy to be useful in grading the severity of fibrosis in chronic hepatitis, but we were concerned about some of the peak assignments in the article.

The signal-to-noise ratio is low in both of the spectra in figures 1 and 2 of their article, and, it is therefore difficult to tell which are genuine resonances and which are noise-related signals. Resonances are attributed to glutamine and glutamate complex and to glycogen and glucose complex when these peaks are not sufficiently distinct from the background noise. Furthermore, the resonance attributed by Dr Cho and colleagues to phosphomonoesters should be more correctly assigned to choline-containing compounds (6–8). This resonance comprises choline, phosphomonoesters such as phosphocholine, and phosphodiesters such as glycerophosphorylcholine (7,9). The terminology used by Dr Cho and colleagues is, therefore, not correct. We show both 1H and 31P MR spectra with more appropriate peak assignments (Figs 1, 2). The phosphomonoester resonance in the 31P MR spectrum is multicomponent and may include phosphoethanolamine, phosphocholine, as well as glycolytic intermediates (7,8).



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  		Figure 1. Water-saturated 1H MR spectrum from a normal liver with a point-resolved spatially localized spectroscopic sequence (1,500/40 [repetition time msec/echo time msec]). Three lipid peaks are due to CH, CH2, and CH3 resonances, and a choline peak is due to choline (Cho) resonance. Peak X is unassigned. PPM = parts per million.

 


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  		Figure 2. Normal hepatic 31P MR spectrum illustrates phosphomonoester (PME), phosphodiester (PDE), inorganic phosphate (Pi), and {gamma}, {alpha}, ß nucleotide triphosphate (NTP) resonances. The spectrum is localized with an image-selected in vivo spectroscopic sequence (10,000/2). The broad component consisting of signals from motion-restricted phospholipid is indicated by the dotted line. PPM = parts per million.

 
Although their study findings provide further evidence that noninvasive imaging methods have a role in the diagnostic armamentarium for evaluating chronic liver disease, they should be interpreted with caution.

FOOTNOTES

Supported by the British Medical Research Council and Philips Medical Systems, Cleveland, Ohio.

REFERENCES

  1. Cho SG, Kim MY, Kim HJ, et al. Chronic hepatitis: in vivo proton MR spectroscopic evaluation of the liver and correlation with histopathologic findings. Radiology 2001; 221:740-746.[Abstract/Free Full Text]
  2. Menon DK, Sargentoni J, Taylor-Robinson SD, et al. Effect of functional grade and etiology on in vivo hepatic phosphorus-31 magnetic resonance spectroscopy in cirrhosis: biochemical basis of spectral appearances. Hepatology 1995; 21:417-427.[CrossRef][Medline]
  3. Jalan R, Sargentoni J, Coutts GA, et al. Hepatic phosphorus-31 magnetic resonance spectroscopy in primary biliary cirrhosis and its relation to prognostic models. Gut 1996; 39:141-146.[Abstract/Free Full Text]
  4. Taylor Robinson SD, Sargentoni J, Bell JD, et al. In vivo and in vitro hepatic 31P magnetic resonance spectroscopy and electron microscopy of the cirrhotic liver. Liver 1997; 17:198-209.[Medline]
  5. Taylor Robinson SD, Sargentoni J, Bell JD, et al. In vivo and in vitro hepatic phosphorus-31 magnetic resonance spectroscopy and electron microscopy in chronic ductopenic rejection of human liver allografts. Gut 1998; 42:735-743.[Abstract/Free Full Text]
  6. Ruiz-Cabello J, Cohen JS. Phospholipid metabolites as indicators of cancer cell function. NMR Biomed 1992; 5:226-233.[Medline]
  7. Bell JD, Cox IJ, Sargentoni J, et al. A 31P and 1H-NMR investigation in vitro of normal and abnormal human liver. Biochim Biophys Acta 1993; 1225:71-77.[Medline]
  8. Taylor Robinson SD, Thomas EL, Sargentoni J, Marcus CD, Davidson BR, Bell JD. Cirrhosis of the human liver: an in vitro 31P nuclear magnetic resonance study. Biochim Biophys Acta 1995; 1272:113-118.[Medline]
  9. Tarasow E, Siergiejczyk L, Panasiuk A, et al. MR proton spectroscopy in liver examinations of healthy individuals in vivo. Med Sci Monit 2002; 8:MT36-40.[Medline]



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