Chronic hepatitis: In vivo proton MR spectroscopic evaluation of the liver and correlation with histopathologic findings

PURPOSE: To correlate the in vivo hydrogen 1 (H-1) magnetic resonance (MR) spectroscopic features of the chronic hepatitis-involved liver with the histopathologic stages of fibrosis. MATERIALS AND METHODS: Seventy-five patients with chronic hepatitis were examined with H-1 MR spectroscopy, which was performed in the right hepatic lobe. The peak areas of glutamine and glutamate complex (Glx), phosphomonoesters (PME), glycogen and glucose complex (Glyu), and lipid were measured on the liver spectra. The histopathologic features were correlated with the in vivo H-1 MR spectroscopic findings at each stage of chronic hepatitis. Fifteen healthy volunteers also were included as a control group, RESULTS: H-1 MR spectroscopy depicted Glx, PME, Glyu, and lipid in all livers. In the normal livers, the calculated mean ( SD) relative metabolite-to-lipid ratios of Glx, PME, and Glyu were 0.14 +/- 0.04, 0.03 +/- 0.01, and 0.21 +/- 0.04, respectively. The mean value of each metabolite-to-lipid ratio was significantly different between all stages of chronic hepatitis, and with the exception of the mean ratio at the interval between stages 0 and 1 (P > .05), the mean value increased significantly with increasing stage (P < .05). A pronounced peak was demonstrated at 3.9-4.1 ppm at H-1 MR spectroscopy of all stages of chronic hepatitis except stage 0. CONCLUSION: The increased Glx, PME, and Glyu levels relative to the lipid content with chronic hepatitis indicated the severity of fibrosis and thus were concordant with the histopathologic stages. In vivo H-1 MR spectroscopy might be a substitute for liver biopsy in the diagnosis and staging of chronic hepatitis.