Taylor-Robinson, Simon David; (1996) Magnetic resonance studies in patients with chronic liver disease and following hepatic transplantation. Doctoral thesis (M.D.), University of London.

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Abstract

Chronic liver disease is a major health problem and liver transplantation is the only form of treatment which prolongs life in end-stage liver disease. However, the current methods of assessing the functional severity of liver injury are not entirely satisfactory, usually depending on a collection of laboratory and clinical factors, which do not always directly reflect underlying hepatic function. Magnetic resonance spectroscopy (MRS) may provide direct biochemical information on hepatic metabolic processes. In this thesis, a combination of in vivo and in vitro phosphorus-31 MRS techniques are used to study liver function in patients with cirrhosis and also hepatic allograft rejection following liver transplantation. The results show that in vivo phosphorus-31 MR spectra vary with the functional severity of chronic liver disease. In vitro phosphorus-31 MRS demonstrates that the underlying biochemical abnormalities are due to changes in phospholipid metabolism and may be used as an indication of hepatic functional reserve. Patients with chronic ductopenic allograft rejection have spectral changes, probably reflecting altered phospholipid secretion into bile in this cholestatic condition. MR spectroscopy may provide an indication of bile duct damage, where early diagnosis is often difficult. A major complication of chronic liver disease is chronic hepatic encephalopathy, the neuropsychiatric abnormality which affects up to 80% of patients. The pathogenesis of the condition is unknown and it is difficult to monitor objectively. MRS may be utilised to study the biochemistry and metabolism of the brain. The cerebral function of encephalopathic patients with biopsy-proven cirrhosis of the liver is studied using standard clinical and electroencephalographic techniques, which are compared with phosphorus-31 and hydrogen-1 (proton) MRS and MR imaging modalities. Results demonstrate spectral changes, which correlate closely with the underlying neuropsychiatric impairment, offering the possibility of studying the pathogenesis and providing an objective means of monitoring treatment modalities and patient responses to them.

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