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Application of localized 31P MRS saturation transfer at 7 T for measurement of ATP metabolism in the liver: reproducibility and initial clinical application in patients with non-alcoholic fatty liver disease

  • Magnetic Resonance
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Saturation transfer (ST) phosphorus MR spectroscopy (31P MRS) enables in vivo insight into energy metabolism and thus could identify liver conditions currently diagnosed only by biopsy. This study assesses the reproducibility of the localized 31P MRS ST in liver at 7 T and tests its potential for noninvasive differentiation of non-alcoholic fatty liver (NAFL) and steatohepatitis (NASH).


After the ethics committee approval, reproducibility of the localized 31P MRS ST at 7 T and the biological variation of acquired hepato-metabolic parameters were assessed in healthy volunteers. Subsequently, 16 suspected NAFL/NASH patients underwent MRS measurements and diagnostic liver biopsy. The Pi-to-ATP exchange parameters were compared between the groups by a Mann–Whitney U test and related to the liver fat content estimated by a single-voxel proton (1H) MRS, measured at 3 T.


The mean exchange rate constant (k) in healthy volunteers was 0.31 ± 0.03 s−1 with a coefficient of variation of 9.0 %. Significantly lower exchange rates (p < 0.01) were found in NASH patients (k = 0.17 ± 0.04 s−1) when compared to healthy volunteers, and NAFL patients (k = 0.30 ± 0.05 s−1). Significant correlation was found between the k value and the liver fat content (r = 0.824, p < 0.01).


Our data suggest that the 31P MRS ST technique provides a tool for gaining insight into hepatic ATP metabolism and could contribute to the differentiation of NAFL and NASH.

Key Points

1D localized 31 P MRS saturation transfer in the liver is reproducible at 7 T

• NASH patients have decreased hepatic Pi-to-ATP exchange rate

• In this study, hepatic metabolic activity correlates with liver fat content

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The scientific guarantor of this publication is Assistant Professor Martin Krššák, Ph.D. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. This study has received funding by the Vienna Spots of Excellence des Wiener Wissenschafts-und Technologie-Fonds (WWTF) - Vienna Advanced Imaging Center (VIACLIC #FA102A0017) and the OeNB Jubilaeumsfond (grant #13629, #13834, #15455) and the Slovak Grant Agency (VEGA grant #2/0013/14 and APVV grant #0513-10). No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Methodology: prospective, experimental, performed at one institution.

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Correspondence to Martin Krššák.

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Valkovič, L., Gajdošík, M., Traussnigg, S. et al. Application of localized 31P MRS saturation transfer at 7 T for measurement of ATP metabolism in the liver: reproducibility and initial clinical application in patients with non-alcoholic fatty liver disease. Eur Radiol 24, 1602–1609 (2014).

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