Cirrhosis diagnostic study of choice

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]


In developing countries, liver biopsy is the gold standard test for the diagnosis of cirrhosis. The presence of bridging fibrous septa, parenchymal nodules bearing a mixture of replicating and sensecent hepatocytes and involvement of most or all of the liver are confirmatory of cirrhosis. Liver biopsy helps in confirmation of the diagnosis, determination of prognosis, underlying etiology, management of rejection subsequent to liver transplantation and evaluation of abnormal hepatic investigations. Sample of the liver may be obtained by Percutaneous, transjugular and laparoscopic radiographically- guided fine-needle approach. However, percutaneous liver biopsy is considered as the cornerstone of diagnosis. In developed countries, Fibroscan (transient elastography) is replacing liver biopsy as the gold standard diagnostic modality.

Diagnostic Study of Choice

Gold standard/Study of choice in developing countries:

Features of liver biopsy[1][2][3][4][5][6][7][8]

Gold standard/Study of choice in developed countries:

  • Fibroscan or transient elastography has now replaced liver biopsy as the gold standard diagnostic modality in developed countries.
  • Transient elastography and the Acoustic Radiation Force Impulse (ARFI) technique are well-established methods for the staging of fibrosis in cirrhosis: [13][14][15][16][17][18][19][20][21][22][23] 
  • The FibroScan (transient elastography) uses elastic waves to determine liver stiffness which theoretically may be converted into a liver score.
  • The FibroScan produces an ultrasound image of the liver (from 20-80mm) along with a pressure reading (in kPa).
  • Transient elastography is much faster than a biopsy (usually lasts 2.5-5 minutes) and is completely painless.
  • Findings on transient elastography may show reasonable correlation with the severity of cirrhosis:[24][25]


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