Diagnostic imaging modalities

With advances in our knowledge and management of cirrhosis, we have faced bigger needs for early and accurate diagnosis of the disease state. Noninvasiveness, simplicity, and repeatability have become essential conditions for these new diagnostic methods. In this aspect, imaging modalities, including ultrasonography (US), computed tomography (CT), and magnetic resonance (MR)-based methods, have been good candidates and there have been advances in many specific techniques derived from these basic methods. Contrast-enhanced ultrasonography (CEUS) is an upcoming new technology and is widening the range of applications to the fibrosis and portal hypertension (PHT) beyond focal liver lesions. There are several types of US-based elastography, including transient elastography (TE), acoustic radiation force impulse (ARFI), and shear-wave elastography (SWE), and they have shown remarkable data for the noninvasive diagnosis of PHT as well as fibrosis. MRI-based elastography is anticipated as the most valuable diagnostic modality in spite of its high cost and a lot of data have been reported recently. In this chapter, we will review this traditional and new imaging technology for the diagnosis of cirrhosis and portal hypertension.