Systematic Review: Imaging-Based Morphological Criteria for Liver Cirrhosis-A Call to Standardise.
| Title: | Systematic Review: Imaging-Based Morphological Criteria for Liver Cirrhosis-A Call to Standardise. |
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| Authors: | Lim MC; Department of Diagnostic Imaging, National University Hospital, Singapore City, Singapore.; Quek EJW; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore City, Singapore.; Chan TYH; Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.; Teng M; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore City, Singapore.; Department of Gastroenterology, Alexandra Hospital, Singapore City, Singapore.; Department of Medicine, Alexandra Hospital, Singapore City, Singapore.; Ng CH; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore City, Singapore.; Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Japan.; Visiting Assistant Professor Graduate School of Medicine, Yokohama City University, Yokohama, Japan.; Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama, Japan.; Gnanavelou M; Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.; Chen VL; Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.; Fallowfield JA; Centre for Inflammation Research, Institute for Regeneration and Repair, University of Edinburgh, Edinburgh, UK.; Zhang H; Department of Radiology, The First Hospital of Jilin University, Changchun, China.; Noureddin M; Houston Methodist Hospital, Houston Research Institute, Houston, Texas, USA.; Ko D; Department of Medicine, Bridgeport Hospital Yale New Haven Health, Bridgeport, Connecticut, USA.; Nah B; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore City, Singapore.; Takahashi H; Division of Metabolism and Endocrinology, Faculty of Medicine, Saga University, Saga, Japan.; Siddiqui MS; School of Medicine, University of Virginia, Charlottesville, Virginia, USA.; Lai JC; Medical Data Analytics Centre, The Chinese University of Hong Kong, Hong Kong, Hong Kong.; Li Ka Shing Institute of Health Sciences and State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, Hong Kong.; Wijarnpreecha K; Division of Gastroenterology and Hepatology, University of Arizona College of Medicine Phoenix, Phoenix, Arizona, USA.; Zheng M; MAFLD Research Centre, Department of Hepatology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.; Key Laboratory of Diagnosis and Treatment for the Development of Chronic Liver Disease in Zhejiang Province, Wenzhou, China.; Kumar R; Department of Gastroenterology, Changi General Hospital, Singapore City, Singapore.; Rattananukrom C; Division of Gastroenterology and Hepatology, Department of Medicine, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand.; Kow A; Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, National University Hospital, Singapore City, Singapore.; Syn N; Department of Biomedical Informatics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.; Department of Pathology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.; Wang YC; Department of Radiology, Zhongda Hospital, Jiangsu Key Laboratory of Molecular and Functional Imaging, School of Medicine, Southeast University, Nanjing, China.; Nakajima A; Graduate School of Medicine, Yokohama City University, Yokohama, Japan.; Tang A; Department of Radiology, Université de Montréal, Montréal, Canada.; Lee JM; Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea.; Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea.; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea.; Huang DQ; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore City, Singapore.; Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.; National University Centre for Organ Transplantation, National University Health System, Singapore City, Singapore.; Muthiah M; Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore City, Singapore.; Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore.; National University Centre for Organ Transplantation, National University Health System, Singapore City, Singapore.; Sirlin CB; Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, California, USA. |
| Source: | Alimentary pharmacology & therapeutics [Aliment Pharmacol Ther] 2026 May; Vol. 63 (9), pp. 1201-1214. Date of Electronic Publication: 2026 Mar 25. |
| Publication Type: | Journal Article; Systematic Review; Review |
| Language: | English |
| Journal Info: | Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 8707234 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1365-2036 (Electronic) Linking ISSN: 02692813 NLM ISO Abbreviation: Aliment Pharmacol Ther Subsets: MEDLINE |
| Imprint Name(s): | Publication: Oxford : Wiley-Blackwell; Original Publication: [Oxford, OX] : Blackwell Scientific Publications, [c1987- |
| MeSH Terms: | Liver Cirrhosis*/diagnostic imaging ; Liver Cirrhosis*/pathology ; Diagnostic Imaging*/standards; Carcinoma, Hepatocellular/diagnostic imaging ; Liver Neoplasms/diagnostic imaging ; Humans ; Practice Guidelines as Topic ; Magnetic Resonance Imaging ; Tomography, X-Ray Computed ; Ultrasonography |
| Abstract: | Background: Cirrhosis is the irreversible architectural endpoint of chronic liver disease and is the greatest risk factor for hepatocellular carcinoma (HCC). Despite its centrality in HCC management algorithms, there are no standardised morphologic criteria for diagnosing cirrhosis on cross-sectional imaging. Criteria used in clinical studies and clinical practice guidelines have not been reviewed systematically. We aim to assess cross-sectional imaging criteria in clinical practice guidelines and clinical studies.; Method: We appraised clinical practice guidelines from major hepatology or radiological associations and conducted a systematic review of MEDLINE and EMBASE to identify original studies using ultrasound, CT, and MRI to diagnose liver cirrhosis from 1 January 2015 to 5 November 2025. Studies were classified as having clear, indirect, or no definition. Bias for diagnostic accuracy studies was assessed using QUADAS-2.; Results: Among 18 clinical practice guidelines, only 3 specified explicit imaging-based criteria for diagnosing cirrhosis in at-risk populations. From 6859 records screened, 73 studies (n = 41,417 patients) met inclusion criteria. Only 4 (5%) studies provided a clear definition, 55 (75%) provided indirect definition, and 14 (19%) provided no imaging criteria. Diagnostic performance of imaging features for cirrhosis varied across modalities. While CT and MRI offered higher specificity for certain features (e.g., regenerative nodules), no single modality or feature was sufficient, highlighting the need for standardised morphological-based criteria applicable for several modalities.; Conclusion: Despite the widespread use of cross-sectional imaging in cirrhosis, there is no consensus-based, standardised imaging definition. This highlights the urgent need for a standardised, morphology-based definition of cirrhosis.; (© 2026 John Wiley & Sons Ltd.) |
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| Contributed Indexing: | Keywords: CT; MRI; liver cirrhosis; portal hypertension; ultrasound |
| Entry Date(s): | Date Created: 20260326 Date Completed: 20260417 Latest Revision: 20260417 |
| Update Code: | 20260420 |
| DOI: | 10.1111/apt.70629 |
| PMID: | 41882492 |
| Database: | MEDLINE |
Journal Article; Systematic Review; Review