Assessment of liver fibrosis by magnetic resonance spectroscopy in asymptomatic children with chronic hepatitis c viral infection

Abstract EN

Background: Chronic hepatitis C is the most common cause of chronic liver disease and cirrhosis.

Egypt is the highest affected country with a prevalence of 22%.In children, seroprevalence of HCV is 0.

2% in children less than 11 years of age and 0.4% in children >11 years of age.

Aim of the work: The purpose of this study was to assess the value of liver biopsy in diagnosis of activity grading and fibrosis staging in early asymptomatic children with chroijic hepatitis C virus infection.

We also aim to evaluate the use of 1H MRS and DW-MRI in assessment of some metabolic components (Glx/lipid, PME/lipid and Glyu/lipid ratios) and ADC of liver tissues and its correlation to the histopathological changes found in liver biopsy.

Subjects and Methods: A cross-sectional study was conducted over a period of two years, included thirty children with asymptomatic chronic hepatitis C virus infection(mean age ± SD 14.1+2.8years) and twenty healthy children as controls were included.

Anti HCV antibodies, HCV RNA PCR, liver function tests, abdominal ultrasonography, MRS and DW-MRI were done for all cases and controls, Liver biopsy was done for all cases.

Results: The results showed that HCV infection was more common in males (83.3%) and 16.7% of patients were obese.

There were two significant risk factors for HCV infection in our patients: positive family history of HCV infection(56.7% ofpatients) and history of previous operation (26.7%).There were significant differences in the results of all liver enzymes (ALT, AST and ALP) in cases than controls.

The results of METAV1R grades showed 29 cases (96.6%) had activity while 17 cases (56.7 %) had fibrosis and TGF-pl in liver tissues was positive in 19 cases (63.3%).

The results of MRS& DW-MRI showed significant differences between cases and controls and positive correlations between the results of 1H MRS with the results of liver biopsy (METAVIR Grades, METAVIR Stages and TGF-pl).

Conclusion:Early diagnosis of asymptomatic chronic hepatitis C is essential to prevent or delay end stage chronic parenchymal liver disease.

TGF-pl in liver tissue may be considered as a useful and better tool than METAVIR score in the assessment of hepatic fibrosis.

1H MRS may be a potential non-invasive helpful diagnostic tool in assessing the staging of asymptomatic chronic hepatitis C as the increase of its metabolites were correlated with histopathological change^.

DW-MRI can be considered an effective method in evaluating liver disease activity in chronic hepatitis C.

Recommendation: we recommend the use of larger sample size to assess different stages of liver fibrosis and the use of 1H MRS in monitoring treatments.