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Noninvasive diagnosis of liver cirrhosis: qualitative and quantitative imaging biomarkers

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Abstract

A diagnosis of cirrhosis initiates a shift in the management of chronic liver disease and affects the diagnostic workflow and treatment decision of primary liver cancer. Liver biopsy remains the gold standard for cirrhosis diagnosis, but it is invasive and susceptible to sampling bias and observer variability. Various qualitative and quantitative imaging biomarkers based on ultrasound, CT and MRI have been proposed for noninvasive diagnosis of cirrhosis. Qualitative imaging features are easy to apply but have moderate diagnostic sensitivity. Elastography techniques allow quantitative assessment of liver stiffness and are highly accurate for cirrhosis diagnosis. Ultrasound elastography are widely used in clinical practice, while MR elastography has narrower availability. Although not applicable in clinical practice yet, other quantitative 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 of liver morphology, perfusion, and function, thus may increase diagnosis performance. The introduction of radiomics and deep learning has further improved diagnostic accuracy while reducing subjectivity. Several imaging features may also help to assess liver function and outcomes in patients with cirrhosis. In this review, we summarize the qualitative and quantitative imaging biomarkers for noninvasive cirrhosis diagnosis, and the assessment of liver function and outcomes, and discuss the challenges and future directions in this field.

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Data availability

The figures are available from the corresponding author, Prof. Bin Song, upon reasonable request.

Abbreviations

cACLD:

compensated advanced chronic liver disease

ADC:

apparent diffusion coefficient

APRI:

aspartate aminotransferase to platelet ratio index

AUC:

area under the curve

BMI:

body mass index

BSA:

body surface area

CEI:

contrast enhancement index

CRL:

caudate to right lobe ratio

CT:

computed tomography

DALY:

disability-adjusted life-year

DWI:

diffusion-weighted imaging

ECV:

extracellular volume fraction

FIB-4:

fibrosis-4 index

FLIS:

functional liver imaging score

HBP:

hepatobiliary phase

HCC:

hepatocellular carcinoma

ICC:

intraclass correlation coefficients

IVIM:

intravoxel incoherent motion

LSN:

liver surface nodularity

LSVR:

liver segmental volume ratio

MRE:

magnetic resonance elastography

MRI:

magnetic resonance imaging

NAFLD:

non-alcoholic fatty liver disease

NASH:

non-alcoholic steatohepatitis

pSWE:

point shear wave elastography

PHLF:

posthepatectomy liver failure

RE:

relative enhancement

RHVC:

right hepatic vein caliber

ROI:

region of interest

SV:

spleen volume

TE:

transient elastography

TLV:

total liver volume

2D SWE:

two-dimensional shear wave elastography

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Acknowledgements

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Funding

This study was funded by the National Natural Science Foundation of China (Grant No. 82101997, 81971571), the Science and Technology Support Program of Sichuan Province (Grant No. 2022YFS0072) and the 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University (Grant No. ZYGD22004).

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  1. Hanyu Jiang and Bin Song contributed equally to this work.

Authors and Affiliations

  1. Department of Radiology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, Sichuan, 610041, China

    Tianying Zheng, Yali Qu, Jie Chen, Hanyu Jiang & Bin Song

  2. Functional and Molecular Imaging Key Laboratory of Sichuan, Chengdu, Sichuan, China

    Tianying Zheng, Yali Qu, Jie Chen, Hanyu Jiang & Bin Song

  3. Department of Medical Ultrasound, West China Hospital, Sichuan University, Chengdu, Sichuan, China

    Jie Yang & Hualin Yan

  4. Department of Radiology, Sanya People’s Hospital, Sanya, Hainan, China

    Bin Song

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Contributions

Conceptualization: TYZ. Funding acquisition: JC, HYJ, BS. Project administration: HYJ, BS. Supervision: HYJ, BS. Visualization: TYZ, YLQ, JC, JY, HLY. Writing-original draft: TYZ. Writing-review & editing: TYZ, YLQ, JC, JY, HLY, HYJ, BS.

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Zheng, T., Qu, Y., Chen, J. et al. Noninvasive diagnosis of liver cirrhosis: qualitative and quantitative imaging biomarkers. Abdom Radiol 49, 2098–2115 (2024). https://doi.org/10.1007/s00261-024-04225-8

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