Diagnostic efficacy of proton magnetic resonance spectroscopy in the management agorithm for critically ill patients with chronic hepatitis of various etiologies
Objective: To determine the diagnostic efficacy of proton magnetic resonance spectroscopy ( 1 H-MRS) in the management algorithm for critically ill patients with chronic hepatitis of various etiologies. Material and methods. This prospective study (2023–2025, Clinical Hospital No. 1, Smolensk) included 30 intensive care unit (ICU) patients with chronic hepatitis (main group) and 21 conditionally healthy volunteers (control group). All participants underwent abdominal ultrasound and magnetic resonance imaging (1.5 T) with 1 H-MRS (PRESS, TE 35 ms, TR 1600 ms, voxel size 17×17×17 mm) for quantitative assessment of N-acetylaspartate (NAA), lipids (Lip), lactate (Lac), aspartate (Asp), and choline (Chol). Patients in the main group underwent 1 H-MRS twice: at admission and after 6 months of therapy. Statistical analysis included the Mann–Whitney U test, Spearman’s correlation (ρ), ROC analysis, logistic regression, and Fisher’s exact test; the significance level was set at p<0.05. Results. ICU patients showed statistically significant (p<0.01) metabolic changes compared to controls: increased Lip (11.5 [9.8; 13.2] c.u.; 86.7% of patients), Lac (49.8 [48.5; 51.2] c.u.; 100%), Asp (4.0 [2.5; 5.0] c.u.; 60%); decreased NAA (–0.8 [–1.5; –0.1] c.u.; 73.3%), and Chol (0.9 [0.2; 2.1] c.u.). The NAA/Lip ratio was below 1 c.u. in 80% of patients (median 0.32 [0.21; 0.48]). ROC analysis showed that NAA/Lip predicts the development of cirrhosis (F4) at 6 months with AUC 0.94 (95% confidence interval (CI) 0.85–0.98); the optimal cut-off value was ><0.95 c.u. (sensitivity 95.8%, specificity 83.3%). All 24 patients with baseline NAA/Lip below the cut-off developed cirrhosis F4 at 6 months. The correlation between NAA/Lip and fibrosis stage was strongly negative (>ρ=–0.89; 95% CI –0.95...–0.77). Chol <1.8 c.u. was also associated with cirrhosis development (AUC 0.88; odds ratio 19.0; 95% CI 2.8–128; p=0.003). Elevated Asp (>2.5 c.u.) was found in 18 (60%) patients; among them, 10 (55.5%) subsequently developed hepatocellular insufficiency (p=0.003, Fisher’s exact test; ρ=0.64). Conclusion. 1 H-MRS is a valuable non-invasive method for assessing metabolic disorders in ICU patients with chronic hepatitis. The NAA/Lip ratio (cut-off <0.95 c.u.), as well as Chol and Asp levels, have high prognostic value for the risk of fibrosis progression to cirrhosis and the development of hepatocellular insufficiency. The method can be used to personalize therapy in situations where invasive biopsy is contraindicated.><0.95 c.u.), as well as Chol and Asp levels, have high prognostic value for the risk of fibrosis progression to cirrhosis and the development of hepatocellular insufficiency. The method can be used to personalize therapy in situations where invasive biopsy is contraindicated.