1H Magnetic Resonance Spectroscopy Predicts Hepatocellular Carcinoma in a Subset of Patients With Liver Cirrhosis: A Randomized Trial

Abstract

The goal of this study was to investigate the utility of H magnetic resonance spectroscopy (H-MRS) to quantify the differences in liver metabolites. Magnetic resonance spectroscopy was used as a means of predicting the probability of developing hepatocellular carcinoma (HCC) in patients with liver cirrhosis secondary to chronic hepatitis B.This study included 20 healthy volunteers, 20 patients with liver cirrhosis secondary to chronic hepatitis B (cirrhosis group), and 20 patients with small HCC secondary to cirrhosis liver parenchyma (HCC group). All patients underwent routine MRI and H-MRS scanning. LCModel software was used to quantify Cho (Choline), Lip (lipid), and Cho/Lip in the 3 groups, and a one-way ANOVA was used to compare the differences in these metabolites between groups.Choline levels were significantly different between the control and HCC group and between the cirrhosis group and the HCC group (all P < 0.001). There was also a significant difference in Lip levels between the control and cirrhosis group and the control and HCC groups (all P < 0.001). There were also differences in Cho/Lip between the control and cirrhosis groups, the control and HCC groups, and the cirrhosis and HCC groups (all P < 0.001).H-MRS followed by the analysis with LCModel can be used to measure changes in hepatic metabolite levels in patients with liver cirrhosis secondary to chronic hepatitis B and HCC. Thus, H-MRS may be helpful in monitoring HCC and liver cirrhosis development.

FIGURE 1

¹H magnetic resonance spectrum and voxel localization images of a 48-year-old healthy volunteer. The ROI is targeted to the lesion and measured 2 × 2 cm². ¹H-MR, ¹H magnetic resonance spectroscopy; ROI, region of interest.

FIGURE 2

¹H magnetic resonance spectrum and voxel localization images of a 58-year-old liver cirrhosis patient secondary to chronic hepatitis B. The ROI is targeted to the lesion and measured 2 × 2 cm². ¹H-MR, ¹H magnetic resonance spectroscopy; ROI, region of interest.

FIGURE 3

¹H magnetic resonance spectrum and voxel localization images of a 57-year-old patient with small HCC. The ROI is targeted to the lesion and measured 2 × 2 cm². HCC, hepatocellular carcinoma; ¹H-MR, ¹H magnetic resonance spectroscopy; ROI, region of interest.

FIGURE 4

Data showing the Cho (A), Lip (B), and Cho/Lip ratio (C) in the control, cirrhosis, and HCC liver parenchyma groups are also presented. Cho, choline; HCC, hepatocellular carcinoma; Lip, lipid.