From the Guidelines
No, sharp liver edges on ultrasound do not indicate cirrhosis, as cirrhosis is typically characterized by blunted, nodular liver edges on ultrasound. In fact, a normal, healthy liver has sharp, well-defined edges on ultrasound imaging 1. When cirrhosis develops, the liver undergoes fibrotic changes and nodule formation, which causes the edges to become rounded or blunted. Other ultrasound findings that suggest cirrhosis include:
- Heterogeneous liver texture
- Surface nodularity
- Enlarged caudate lobe relative to the right lobe
- Signs of portal hypertension such as splenomegaly and ascites The presence of sharp liver edges on ultrasound generally suggests normal liver architecture without significant fibrosis or cirrhosis. However, ultrasound alone is not definitive for diagnosing or excluding cirrhosis, and clinical correlation with laboratory tests, patient history, and sometimes liver biopsy is necessary for accurate diagnosis, as noted in the American College of Radiology's appropriateness criteria for chronic liver disease 1.
It's worth noting that advanced techniques such as MR elastography and US have been shown to be more accurate than conventional morphological imaging methods for assessing liver fibrosis and cirrhosis 1. Additionally, contrast-enhanced US (CEUS) is becoming established as an accurate technique for assessment of liver masses, including hepatocellular carcinoma (HCC), which is a common complication of cirrhosis 1.
From the Research
Liver Edges on Ultrasound and Cirrhosis
- Sharp liver edges on ultrasound do not typically indicate cirrhosis, as cirrhosis is often characterized by a nodular liver surface and round edge 2, 3.
- A study from 1994 found that characteristic findings of liver cirrhosis in ultrasound include a nodular liver surface, round edge, and hypoechoic nodules in liver parenchyma 2.
- Another study from 1992 found that diffuse surface irregularity was a sign of cirrhosis, with a sensitivity of 87.5% and specificity of 81.5% 3.
- However, none of the studies directly mention sharp liver edges as an indicator of cirrhosis, suggesting that this may not be a reliable sign for diagnosis.
Diagnostic Methods for Cirrhosis
- Ultrasound is a useful non-invasive tool for diagnosing liver cirrhosis, and can detect signs such as nodular liver surface, round edge, and hypoechoic nodules 2, 4.
- Other non-invasive tests, such as transient elastography, can also be used to diagnose cirrhosis, and may be more accurate than ultrasound in some cases 4.
- A combination of ultrasound and transient elastography may offer the best diagnostic performance for cirrhosis 4.