From the Guidelines
The most sensitive non-invasive test for diagnosing liver cirrhosis is VCTE (Vibration-Controlled Transient Elastography), with a sensitivity of 0.90 and specificity of 0.87, as reported in the 2017 American Gastroenterological Association Institute guideline 1.
Diagnosis of Liver Cirrhosis
When considering the diagnosis of liver cirrhosis, it's crucial to weigh the benefits and limitations of various diagnostic tools. While liver biopsy remains the gold standard for diagnosing liver cirrhosis, its invasive nature and associated risks make non-invasive alternatives attractive.
- Non-invasive tests such as VCTE, APRI, and FIB-4 offer a valuable alternative for diagnosing liver cirrhosis.
- VCTE, in particular, has been shown to have high sensitivity and specificity for diagnosing cirrhosis in patients with NAFLD, as demonstrated in the 2017 guideline 1.
- Other non-invasive tests, such as APRI and FIB-4, also have their own strengths and weaknesses, with APRI having a sensitivity of 0.78 and specificity of 0.71, and FIB-4 having a sensitivity of 0.74 and specificity of 0.71, as reported in the same guideline 1.
Choosing the Best Diagnostic Tool
In clinical practice, the choice of diagnostic tool depends on various factors, including patient characteristics, disease severity, and availability of resources.
- For patients with NAFLD, VCTE is a reasonable choice for diagnosing liver cirrhosis, given its high sensitivity and specificity.
- However, it's essential to consider the limitations of each test, including the potential for false positives and false negatives, and to use a combination of tests and clinical assessment to make an accurate diagnosis.
- As noted in the 2016 KASL clinical practice guidelines, various blood marker panels, such as APRI and FIB-4, can also be used to evaluate liver fibrosis, although their effectiveness may vary depending on the patient population and disease severity 1.
From the Research
Diagnostic Tests for Liver Cirrhosis
The following tests have been found to be sensitive for the diagnosis of liver cirrhosis:
- Transient elastography (TE) with a cut-off value of 13.1 kPa, which identified patients with cirrhosis with 100% sensitivity and 89% specificity 2
- Magnetic resonance imaging (MRI) with a sensitivity of 87% and specificity of 92% 3
- FibroScan with optimal cut-off values for liver cirrhosis diagnosis ranging from 8.70 to 11.75 kPa 4
- Abdominal ultrasound combined with laboratory tests, which had an area under the curve of 92.4% for the correct diagnosis of advanced fibrosis and cirrhosis 5
Characteristics of Diagnostic Tests
The diagnostic tests for liver cirrhosis have the following characteristics:
- TE: high sensitivity and specificity, can identify all cases of cirrhosis and has a high negative predictive value 2
- MRI: high sensitivity and specificity, can detect occult hepatocellular carcinomas and has characteristic features such as enlargement of segment one and narrowing of hepatic veins 3
- FibroScan: moderate accuracy for liver fibrosis diagnosis and oesophageal varices prediction, can be combined with APRI and FIB-4 for high specificity 4
- Abdominal ultrasound: excellent accuracy when combined with laboratory data, can diagnose advanced fibrosis and cirrhosis with high sensitivity and specificity 5
Non-Invasive Imaging Modalities
Non-invasive imaging modalities such as transient elastography, acoustic radiation force impulse imaging, and magnetic resonance-based methods have been developed for the diagnosis of cirrhosis 6