Diagnosis of cirrhosis and portal hypertension: imaging, non-invasive markers of fibrosis and liver biopsy

Abstract

The concept of 'cirrhosis' is evolving and it is now clear that compensated and decompensated cirrhosis are completely different in terms of prognosis. Furthermore, the term 'advanced chronic liver disease (ACLD)' better reflects the continuum of histological changes occurring in the liver, which continue to progress even after cirrhosis has developed, and might regress after removing the etiological factor causing the liver disease. In compensated ACLD, portal hypertension marks the progression to a stage with higher risk of clinical complication and requires an appropriate evaluation and treatment. Invasive tests to diagnose cirrhosis (liver biopsy) and portal hypertension (hepatic venous pressure gradient measurement and endoscopy) remain of crucial importance in several difficult clinical scenarios, but their need can be reduced by using different non-invasive tests in standard cases. Among non-invasive tests, the accepted use, major limitations and major benefits of serum markers of fibrosis, elastography and imaging methods are summarized in the present review.

Keywords: compensated advanced chronic liver disease; elastography; hepatic venous pressure gradient; ultrasound.

Figure 1.

Natural history of diagnostic on-invasive diagnostic tests in compensated advanced chronic liver disease. The most appropriate timeframe for using different techniques in order to maximize the information for clinical use is given. Combination of different non-invasive unrelated tests can further improve the amount of information retrieved and reduce the risk of false-positive and false-negative results.