Non Alcoholic Fatty Liver disease (NAFLD) comprises two groups of patients; one group withsimple steatosis which is relatively benign and one group with NASH which may progress to cirrhosis and hepatocellular carcinoma. Up to now the only means of distinguishing the two was to perform a liver biopsy. Phosphorus magnetic resonance spectroscopy (31P-MRS), which allows non-invasive in vivo assessment of hepatocellular metabolism, was proven to show potential to distinguish the type of NAFLD.
The accuracy of the imaging technique could improve clinical procedures and enhance patientexperience compared to the discomfort and risk of undergoing the 'gold standard' test (liver biopsy) currently used for diagnosing NAFLD. These results will now need to be prospectively confirmed in independent cohorts.
NASH is a more advanced form of NAFLD and its incidence and prevalence is rising. Although CT and ultrasound scans are potential diagnostic tools for NAFLD, currently only liver biopsy can confirm whether the simpler NAFLD is present or whether the more serious NASH has developed.
Using 31PMRS, the liver metabolite changes from 132 patients with biopsy-proven NAFLD were obtained and the diagnostic performance of 31P-MRS for NASH was determined.
31P-MRS shows distinct alterations in ATP and PDE levels which are concordant with putative mechanisms in the progression of NAFLD. 31P-MRS shows fair diagnostic accuracy for NAFLD compared with liver biopsy, and using certain thresholds can be considered a reliable diagnostic tool for NASH.