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31P MR Spectroscopy in Assessment of Response to Antiviral Therapy for Hepatitis C Virus–Related Liver Disease

¹ Department of Imaging Sciences, Faculty of Medicine, Imperial College London, Robert Steiner MRI Unit, MRC Clinical Sciences Centre, Hammersmith Hospital, Du Cane Rd., London W12 0HS, United Kingdom.
² Liver Unit, Division of Medicine, Imperial College London, St. Mary's Hospital, London, United Kingdom.
³ Department of Medical Imaging, Faculty of Medicine, School of Medicine, Kaohsiung Medical University, Taiwan.
⁴ Department of Histopathology, Faculty of Medicine, Imperial College London, St. Mary's Hospital, London, United Kingdom.

OBJECTIVE. An increase in the ratio of phosphomonoester (PME) to phosphodiester (PDE) during ³¹P MR spectroscopy of the liver has been observed with increasing severity of hepatitis C–related liver disease. The purpose of this study was to investigate the utility of ³¹P MR spectroscopy as a biomarker of response to interferon and ribavirin treatment.

SUBJECTS AND METHODS. Forty-seven patients with biopsy-proven hepatitis C undergoing viral eradication treatment with interferon and ribavirin underwent hepatic ³¹P MR spectroscopy at 1.5 T (voxel size, 70 x 70 x 70 mm; TR, 10,000; number of signals averaged, 48). All underwent baseline imaging before treatment and repeated imaging at 6-month intervals after the start of treatment.

RESULTS. All patients underwent follow-up imaging 6 months after the start of treatment; 25 patients, 12 months; and 10 patients, 18 months after the start of treatment. According to the Ishak histologic scoring system, nine patients had mild hepatitis; 30 patients, moderate to severe hepatitis; and eight patients, cirrhosis. Thirty-two patients responded to antiviral treatment. Among these patients, 25 had a decrease in PME/PDE ratio on follow-up imaging. Among responders the mean baseline PME/PDE ratio decreased from 0.27 ± 0.02 (standard error) to 0.16 ± 0.01 after treatment (paired Student's t test, p < 0.001). Among the 15 virologic nonresponders, the ratios were similar in six patients; six other patients had an increase on follow-up imaging. In the latter nonresponder group, the mean baseline PME/PDE ratio was 0.21 ± 0.03 compared with 0.31 ± 0.08 after treatment (paired Student's t test, p =0.24).

CONCLUSION. The in vivo hepatic PME/PDE ratio decreased in patients with hepatitis C who responded to antiviral treatment and remained similar or increased in patients without a virologic response. These results suggest that PME and PDE can be used as biomarkers in a noninvasive test of response to treatment.

Keywords: hepatitis C • phospholipids • ³¹P MR spectroscopy

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