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.

Incidence of Hepatocellular Carcinoma in Patients With HCV-Associated Cirrhosis Treated With Direct-Acting Antiviral Agents

“…In about one-third of patients, diagnosis of cirrhosis was confirmed by the presence of EV at the time of EGS surveillance (25). Although the diagnosis of cirrhosis was based on platelet count in only 11 patients, platelet count is a validated serum test for diagnosis of advanced fibrosis or cirrhosis (26). Mean age of our patient cohort was considerably higher than that of previous cohorts treated with IFN-based therapy.…”

Management of portal hypertension and ascites in polycystic liver disease

“…Even though HVPG is mandatory according to the definition of (clinically significant) portal hypertension, it is not universally performed in a standard fashion when evaluating cirrhotic patients. 46 Furthermore, measurement of HVPG can be particularly technically challenging in patients with PLD because of the distorted anatomy. 12 With lack of reporting of HVPG measurements in the literature, its use for PLD patients requires further clarification and validation in future studies.…”

An Updated Review on the Epidemiology, Pathophysiology, Etiology and Diagnosis of Liver Cirrhosis

“…It can even detect ascites, and with the Doppler, it can help discover signs of portal hypertension. Findings of nodularity, hypertrophy of the caudate lobe, increased echogenicity and parenchymal atrophy are sonographic signs of cirrhosis [80,81].…”