What are the diagnostic criteria for liver cirrhosis?

From the Guidelines

Liver cirrhosis is diagnosed through a combination of clinical findings, laboratory tests, imaging studies, and sometimes liver biopsy, with transient elastography (FibroScan) values above 12 kPa having >90% specificity for diagnosing advanced fibrosis and compensated cirrhosis, as suggested by the most recent guidelines 1. The diagnostic criteria for liver cirrhosis include:

• Physical examination findings such as jaundice, spider angiomas, palmar erythema, ascites, and hepatomegaly or a shrunken liver
• Laboratory tests showing elevated liver enzymes (AST, ALT), increased bilirubin, decreased albumin, prolonged prothrombin time, and thrombocytopenia
• Imaging studies like ultrasound, CT scan, or MRI revealing a nodular liver surface, splenomegaly, and signs of portal hypertension
• Transient elastography (FibroScan) can non-invasively assess liver stiffness, with values above 12 kPa strongly suggesting advanced fibrosis and compensated cirrhosis, as defined by the Baveno VI recommendations 1
• Liver biopsy remains the gold standard for definitive diagnosis, showing fibrosis with nodule formation and disruption of normal liver architecture Additional diagnostic criteria include signs of hepatic decompensation such as hepatic encephalopathy, variceal bleeding, and spontaneous bacterial peritonitis. The etiology of cirrhosis should also be determined through specific tests for viral hepatitis, autoimmune markers, iron studies, ceruloplasmin levels, or alcohol use history, as identifying and treating the underlying cause is crucial for management, as emphasized by recent studies 1. Early diagnosis is important as it allows for interventions that may slow disease progression and prevent complications, and the use of non-invasive tests such as transient elastography and MR elastography can help identify patients at risk of developing clinical events, as recommended by the American College of Radiology Appropriateness Criteria 1.

From the Research

Diagnostic Criteria for Liver Cirrhosis

The diagnostic criteria for liver cirrhosis involve a combination of clinical evaluation, laboratory tests, and imaging studies.

• Liver biopsy remains the gold standard for cirrhosis diagnosis, but it is invasive and susceptible to sampling bias and observer variability 2.
• Noninvasive testing, including laboratory tests, combination scoring indices, and imaging (eg, ultrasonography, transient elastography), is commonly used for diagnosis 3.
• Qualitative imaging features, such as those obtained through ultrasound, CT, and MRI, can be used for diagnosis, but have moderate diagnostic sensitivity 2.
• Quantitative imaging biomarkers, including elastography techniques, can provide a more accurate assessment of liver stiffness and are highly accurate for cirrhosis diagnosis 2, 4.
• Serum markers, such as the aspartate transaminase to platelet ratio index score, Fibrosis 4 score, and FibroTest/FibroSure, can be used to assess fibrosis and cirrhosis 5.

Imaging Studies for Liver Cirrhosis

Imaging studies play a crucial role in the diagnosis of liver cirrhosis.

• Ultrasound elastography is widely used in clinical practice for the assessment of liver stiffness 2.
• MR elastography has narrower availability but can provide a quantitative assessment of liver stiffness 2.
• Other imaging features, including liver surface nodularity, linear and volumetric measurement, extracellular volume fraction, liver enhancement on hepatobiliary phase, and parameters derived from diffusion-weighted imaging, can provide additional information on liver morphology, perfusion, and function 2.

Laboratory Tests for Liver Cirrhosis

Laboratory tests are essential for the diagnosis and management of liver cirrhosis.

• Liver function tests, including complete blood count, liver function tests, and prothrombin time/international normalized ratio, can help identify patients with cirrhosis 3, 5.
• Viral hepatitis serologies, ferritin, and transferrin saturation can help identify the underlying cause of cirrhosis 5.
• The Child-Pugh and Model for End-stage Liver Disease (MELD) scores can be used to assess the severity of cirrhosis and predict outcomes 3, 5.