Hepatitis C virus (HCV) accounts for about a third of liver transplants and a large proportion of the increasing incidence of hepatocellular carcinoma. MRI is noninvasive and can be cost effective if performed rapidly and without contrast agents. The purpose of this investigation is to determine whether a quick and noninvasive MRI examination can accurately grade the level of inflammatory activity and stage the amount of fibrosis in HCV patients, thereby potentially reducing the number of liver biopsies needed. Forty patients per year with chronic HCV infection who are undergoing diagnostic evaluation will be selected from our hepatology practice. All patients will have MR imaging performed within 1 month prior to or following core liver biopsy. MRI exams and biopsy specimens will be examined independently by, respectively, two radiologists and two pathologists, all blinded to other clinical and imaging data. MRI interpretations will include measurement of lymph node number, size and signal intensity. These parameters will be compared with the histologic grade of inflammatory activity. We will evaluate morphologic signs of early cirrhosis that have been established by prior investigations at our institution, including empty gallbladder fossa, enlarged periportal space, and increased caudate to right lobe ratio, and will determine if these signs are sufficiently accurate to identify patients who have developed hepatic fibrosis. We will also measure hepatic fibrosis through new MR spectroscopic techniques, and compare this with histologic results. We will use established MRI methods for measuring hepatic lipid, and determine if its presence affects the accuracy of MR spectroscopic measurement of fibrosis. We will record the duration of the MR examination to determine whether this data can be acquired within 30 minutes. Our hypotheses are as follows: 1. Patients with more active HCV will have more perihepatic lymph nodes greater than 5 mm. 2. Patients with more active HCV will have larger lymph nodes. 3. Patients with more active HCV will have more hyperintense perihepatic lymph nodes. 4. Number, size, and hyperintensity of perihepatic lymph nodes can differentiate mild HCV from higher grades of activity. 5. Signs of early cirrhosis (empty gallbladder fossa, enlarged periportal space, increased caudate to right lobe ratio) can diagnose patients with fibrosis. 6. MRI determination of the fraction of signal intensity from lipid will be higher in patients with histologic findings of fatty liver. 7. MR spectroscopic measurement of fibrosis can diagnose presence/absence of fibrosis. 8. MR diagnosis of fibrosis will be less accurate in patients with fatty livers. 9. The average duration of MR examinations will be 30 minutes or less.
