In his recent commentary, Pinzani discussed approaches to non-invasive evaluation of liver fibrosis and addressed some of the methods currently under investigation (Gut 2006;55:310–12). We agree that liver histology is a surrogate end point and Pinzani emphasised the need for longitudinal studies based on hard clinical endpoints. However, he states “At present, CT and MR can indicate the presence of cirrhosis with high specificity but with very low sensitivity”. In reply, we wish to counter this statement and would like to present data from emerging technologies, including magnetic resonance spectroscopy (MRS), ultrashort echo time (UTE) MR imaging (MRI), and microbubble ultrasound.

We used 31P MRS in vivo to characterise hepatic fibrosis in chronic hepatitis C (CHC) infection.¹ The phosphomonoester to phosphodiester (PME/PDE) ratio provided an index of cell membrane turnover and was found to correlate closely with disease severity, assessed by liver histology (Ishak system). A PME/PDE ratio ⩾0.3 provided a sensitivity and specificity of 82% and 81%, respectively, for the diagnosis of cirrhosis, comparable with many indirect serological markers. There was a monotonic increase in …