Magnetic Resonance Spectroscopy Study Of Chronic Hepatitis C, Cirrhosis And Using Spectroscopic Imaging To Assess The Effect Of Antiretroviral Therapy

Objective：To investigate changes in magnetic resonance spectroscopy metabolites ofchronic hepatitis C and cirrhosis caused by hepatitis C. And to assess antiviraltreatment efficacy in chronic hepatitis C, cirrhosis of the liver caused by the hepatitisC using valuable changes.Method1.45cases of hepatitis C and cirrhosis of the liver caused by hepatitis C whohave liver biopsy results,26were male and19females, aged34-66years, mean44.2years old. All enrolled patients were naive to anti-viral treatments. Other inclusioncriteria were:(1) HCV RNA>500copies/mL;(2) absence of complications such asgastrointestinal bleeding, hepatic encephalopathy, and primary liver cancer; and (3)liver function defined as Child-Pugh grade A or B based on encephalopathy, andprothrombin time. Patients with hypersplenism were also enrolled. Exclusion criteriawere:(1) Infection infection with hepatitis A, B, D, or F virus, Epstein-Barr virus,cytomegalovirus, or human immunodeficiency virus; and (2) Presence presence ofalcoholic or drug-induced liver diseases, or severe heart, brain, or kidney disease.According to the2003branch of the Chinese Medical Association to develop liverfatty liver disease classification criteria for grading liver fat content[24],Hepaticsteatosis30%to50%of mild fatty liver;50%to75%for the moderate fatty liver;over75%of severe fatty liver. Fatty degeneration of the field of vision is less than30%of liver cells is not enough on fatty liver standard, known as hepatic steatosis, isno fatty liver. They were scored according to the Ishak system, The subdivisionof these patients into mild and moderate disease was based on the Ishak fibrosis (F)and necroinflammatory (NI) scoring system: mild hepatitis (F≤2andNI≤3),moderate hepatitis (3≤F＜6and NI＞4) and Cirrhosis(F＝6).They wereperformed3.0T MRI1H-MRS and31P-MRS scans. Patients of1H-MRS study groupwill be divided into no fatty liver, mild fatty liver group, moderate and severe fattyliver fatty liver group. Reconstruction1H-MRS spectra obtained water peak, the area under water peak, fat peak, the area under fat peak. Based on the above data, ratio ofthe fat peak to the water peak and ratio of the area under fat peak to the area underwater peak were calculated. Compared with the pathological analysis whether theabove parameters are statistically significant. Patients will be divided into mildhepatitis, moderate hepatitis, cirrhosis, and15healthy volunteers as a control group in31P-MRS study. To reconstruct the curve of31P-MRS spectral, and obtain the curvefrom left to right PE, PC, Pi, GPE, GPC, γ-ATP, α-ATP, β-ATP. According to eacharea under the peak we can calculate the percentage of the area. Compared with thepathological analysis whether the above parameters are statistically significant.2. The54patients of chronic hepatitis C and cirrhosis caused by hepatitis C (afterinclusion criteria and exclusion criteria selection) before receiving antiretroviraltreatment and six months later after antiretroviral treatment, respectively perform1H-MRS and31P MRS scan. To analyze the changes of water peak, the area underwater peak, fat peak, the area under fat peak, ratio of the fat peak to the water peakand ratio of the area under fat peak to the area under water peak respectively in1H-MRS. And changes of metabolites (PE+PC)/(GPE+GPC) in31P-MRS.Result:1.45cases of patients who have liver biopsy results, and one case of1H-MRSwas not successful.44cases of successful cases, the difference between the differentlevels of pathology analysis of variance showed differences of fat peak, the area underfat peak, ratio of the fat peak to the water peak and ratio of the area under fat peak tothe area under water peak were statistically significant. With the increase of theseverity of fatty liver, each index value correspondingly increase (P <0.05). Pairwisecomparison results mean difference between groups of display, fat peak, the areaunder fat peak, ratio of the fat peak to the water peak and ratio of the area under fatpeak to the area under water peak were statistically significant in the non-fatty livergroup and moderate fatty liver group, no difference between group and severe fattyliver fatty liver group and a group with mild to moderate fatty liver fatty liver group,moderate and severe fatty liver fatty liver group(P<0．05)， between non-fatty liver group and mild fatty liver group difference was not statistically significant (P>0.05).6cases were not successful in31P MRS,39cases of successful cases based on Isbakscoring system, Mild hepatitis,13cases (33.33%), moderate hepatitis,15cases(38.46%), cirrhosis,11cases (28.21%). With the increase of disease severity, PC+PE%increased significantly, GPC+GPE%reduction, PC+PE%between the groupswas statistically significant, The PC+PE/GPC+GPE increased this differencebetween the groups was statistically significance obviously. Among other metabolitesgroup (Pi%, γ-ATP%, α-ATP%, β-ATP%) was not statistically significant.2.54patients of chronic hepatitis C, cirrhosis of the liver caused by the hepatitisC comparing before receiving antiretroviral therapy with after6months treatment fatpeak, the area under fat peak, ratio of the fat peak to the water peak and ratio of thearea under fat peak to the area under water peak were statistically significant betweenthe control group and the treatment group.32patients sustained viral response toantiviral therapy.25cases in these patients ratio of the fat peak to the water peak andratio of the area under fat peak to the area under water peak were decline in follow-upmagnetic resonance spectroscopy after six months, P <0.05. Seven cases similar to theprevious after treatment.12cases of the virus non-responders11cases are similar tothe previous after treatment in ratio of the fat peak to the water peak and ratio of thearea under fat peak to the area under water peak. In the control group and thetreatment group before treatment PME/PDE was no significant difference, after sixmonths treatment, the difference was statistically significant. In the treatment group,PC+PE/GPC+GPE ratio was significantly reduced after antiretroviral therapycompared with prior, no significant change in the control group.32patients withsustained virological response to antiviral therapy,in these patients, PME/PDE ratiodecreased in25patients after antiretroviral therapy (78%),four cases had no change,while three cases increased slightly.12cases non-responders patients,1patient (8%)PME/PDE ratio decreased, two cases almost unchanged, nine cases increased slightly,p <0.05. Conclusion:MR spectroscopy is a noninvasive method,which can provide information onliver cell metabolism.1H-MRS can be quantitatively assess the extent of fatdeposition,31P-MRS can accurately reflect hepatitis C liver cell metabolism.Application of1H-MRS and31P-MRS in patients with chronic hepatitis C can beused as antiviral therapy and the indicator of the degree of fat deposition.