Is the combination of ultrasonographic findings of the liver and simple blood tests useful to identify compensated hepatitis B cirrhosis?


Dr Michio Imawari, Department of Gastroenterology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo 142-8666, Japan. Email:

In the current issue of the Journal of Gastroenterology and Hepatology, Chen et al.1 report a new model to predict compensated cirrhosis due to hepatitis B virus (HBV) infection using the findings of ultrasonographic examination of the liver and blood tests. The distinction of early compensated cirrhosis from precirrhotic chronic hepatitis due to HBV infection is important to decide the timing of antiviral therapy against HBV infection in order to prevent progression to uncompensated cirrhosis in patients with elevated serum alanine aminotransferase (ALT),2 although it should be noted that the development of hepatocellular carcinoma in patients with HBV infection does not necessarily depend on the existence of cirrhosis.3

The gold standard for diagnosis of the stage of chronic liver disease is the histological findings of liver biopsy specimens. However, liver biopsy is invasive and sometimes causes severe complications. Thus simple, inexpensive and non- or minimally invasive methods are needed to assess the stage of chronic liver disease in the setting of routine clinical practice. Many studies have reported on models to diagnose cirrhosis4 or severe fibrosis5,6 in patients with chronic hepatitis C virus infection. These have used several blood tests and factors such as gender or age. The accuracy of those methods is reasonable with a sensitivity of 80–86% and a likelihood ratio of 8–45. However, similar studies on chronic HBV infection are rare. Furthermore, Zheng et al.7 have reported that the combination of serum levels of hyaluronic acid, type III procollagen, N-terminal procollagen peptide III, laminin, and type IV collagen could not effectively assess the stage of fibrosis in patients with chronic HBV infection.

Chen et al.1 combined the ultrasonographic findings of the liver, patient's age, blood platelet count, and serum albumin and bilirubin levels to construct their model for cirrhosis index. It has been previously reported that a scoring system composed of liver surface irregularity, parenchymal texture, the change of intrahepatic vessels and spleen size on ultrasonography can effectively diagnose cirrhosis with a sensitivity of 74%, a specificity of 84%, and a likelihood ratio of 4.6 in patients with chronic HBV infection and elevated ALT levels.8 The new model diagnosed cirrhosis with a sensitivity of 81%, a specificity of 83% and a likelihood ratio of 12. Notably, the authors included only patients with early stage cirrhosis, as reflected by the normal surface pattern on ultrasonography in all patients studied. Although the validity of this new model has now to be confirmed by others, it seems to be a very useful non-invasive approach to diagnose early cirrhosis due to HBV infection.