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Advancements in the Diagnosis and Management of Liver Disease and...
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Advancements in the Diagnosis and Management of Liver Disease and Liver Transplantation

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Medical Imaging and Theranostics".

Deadline for manuscript submissions: closed (28 February 2026) | Viewed by 8628

Special Issue Editor

Prof. Dr. Ioana Gabriela Lupescu

E-Mail Website
Guest Editor
Radiology, Medical Imaging and Interventional Radiology Department, Fundeni Clinical Institute, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
Interests: multiparametric MRI (MPMRI); multidetector CT (MDCT); focal and diffuse liver pathology; liver transplantation; specific liver contrast material; advanced imaging techniques
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The aim of this Special Issue is to present the multiparametric imaging used to evaluate focal and diffuse liver pathology, as well as the transplanted liver with an emphasis on advanced imaging techniques (such as spectral computed tomography, CT perfusion of the liver, functional MRI, MR elastography, and mapping T1 and T2), hepatocytic specific contrast material, and imaging biomarkers. Further, this Special Issue will highlight the key points used for rapid and correct imaging diagnostics, the role of interventional radiology in liver tumor treatment and liver transplant complications, and the role of a multidisciplinary team in the management of patients with liver disease or with liver transplantation.

Prof. Dr. Ioana Gabriela Lupescu
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • focal and diffuse liver pathology
  • liver transplantation
  • MPMRI
  • MDCT
  • advanced imaging techniques
  • specific liver contrast material
  • imaging biomarkers
  • interventional radiology

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Published Papers (5 papers)

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Research

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14 pages, 1791 KB  
Article
Adding Estimates of Central Venous Pressure Boosts the Performance of Non-Invasive Assessment of the Portosystemic Gradient Prior to TIPS Implantation
by Fabian Stoehr, Maximilian Moos, Lukas Müller, Tilla Loew, Annika Merzweiler, Christian Labenz, Tobias Jorg, Simon Johannes Gairing, Peter R. Galle, Roman Kloeckner, Jens Mittler, Michael B. Pitton, Tobias Bäuerle and Felix Hahn
Diagnostics 2026, 16(7), 1091; https://doi.org/10.3390/diagnostics16071091 - 4 Apr 2026
Viewed by 337
Abstract
Background: Non-invasive scoring systems for predicting the hepatic venous pressure gradient (HVPG) and, thus, clinically significant portal hypertension (CSPH) have been proposed; the aim of this study was to evaluate the accuracy of these scores in a cohort of patients undergoing transjugular [...] Read more.
Background: Non-invasive scoring systems for predicting the hepatic venous pressure gradient (HVPG) and, thus, clinically significant portal hypertension (CSPH) have been proposed; the aim of this study was to evaluate the accuracy of these scores in a cohort of patients undergoing transjugular intrahepatic portosystemic shunt (TIPS) placement and to further analyze patients without a markedly elevated portosystemic gradient (PSG) at the time of the procedure. Methods: We retrospectively analyzed 314 patients who underwent TIPS implantation at our tertiary care center between 2010 and 2022. The diagnostic performance of CT-based scoring systems by Iranmanesh (Score 1) and Kihira (Score 2), as well as laboratory-based scores including MELD (Score 3), FIB-4 (Score 4), and APRI (Score 5), was assessed for detecting a markedly elevated PSG (PSG > 10 mmHg). Additionally, we evaluated whether incorporating the inferior vena cava (IVC) diameter as a surrogate marker of central venous pressure (CVP) improves the accuracy of CT-based scores. Results: Both Scores 1 and 2 showed high sensitivity (89–87%) but low specificity (33–27%). ROC analysis revealed AUC values between 0.65 and 0.62. Laboratory-based scores (Score 3–5) performed poorly with AUCs of 0.57–0.54. Adding IVC diameter as an estimator for CVP to Scores 1 and 2 significantly increased the AUC to 0.74 and 0.76. In Lasso regression, IVC diameter was selected as a significant variable for PSG estimation. Conclusions: CT-based scoring systems showed promise in assessing markedly elevated PSG, but their specificity was low. Including the IVC diameter improved accuracy in detecting elevated PSG in TIPS patients. Future scoring systems should incorporate CVP estimators like the IVC diameter. Full article
(This article belongs to the Special Issue Advancements in the Diagnosis and Management of Liver Disease and Liver Transplantation)
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16 pages, 1098 KB  
Article
Prognostic Value of Exercise Testing in Patients with Liver Cirrhosis
by Teresa John, Alexander Avian, Gabor Kovacs, Peter Fickert, Vasile Foris, Maximilian Gumpoldsberger, Nikolaus John, Antonia Laule, Horst Olschewski, Vanessa Stadlbauer, Nikolaus Kneidinger, Rudolf Stauber and Philipp Douschan
Diagnostics 2026, 16(7), 1036; https://doi.org/10.3390/diagnostics16071036 - 30 Mar 2026
Viewed by 414
Abstract
Background/Objectives: Cirrhosis is associated with increased mortality. In this study, we aimed to investigate the prognostic relevance of 6-min-walk-distance- and cardiopulmonary exercise testing (CPET)-derived peak oxygen uptake (VO2) as estimates of exercise capacity in outpatients with cirrhosis. Methods: Patients underwent [...] Read more.
Background/Objectives: Cirrhosis is associated with increased mortality. In this study, we aimed to investigate the prognostic relevance of 6-min-walk-distance- and cardiopulmonary exercise testing (CPET)-derived peak oxygen uptake (VO2) as estimates of exercise capacity in outpatients with cirrhosis. Methods: Patients underwent a comprehensive clinical characterization including cardiopulmonary exercise testing, six-minute-walking-test-derived distance, and echocardiography. We stratified the cohort using established prognostic thresholds for the six-minute-walking-test-derived distance (440 m) and peak VO2 (65% predicted) and Child–Pugh class (A vs. B/C). Competing risk analyses were performed using cumulative incidence functions and subdistribution hazard models to assess the impact of baseline variables on mortality, accounting for liver transplantation (LT) as a competing event and for age and sex. The prognostic value of exercise performance was analyzed first, followed by the stepwise inclusion of additional variables; multicollinearity precluded a full multivariable model. Results: We enrolled 197 patients in Child–Pugh Class A, B, and C (N = 92, N = 80, N = 25 patients; male N = 146, age: 56 ± 9 years). During the observation time of 85 (25–105) months, 48 patients underwent a liver transplant, and 88 died. Both the six-minute-walking-test-derived distance ≤ 440 m (p = 0.002, sHR: 0.996 95% CI: 0.993–0.998) and peak VO2 ≤ 65% predicted (p = 0.023, sHR: 0.987 95% CI: 0.976–0.998) were strong independent predictors of mortality. While the six-minute-walking-test-derived distance consistently remained significant across most models, the peak VO2 retained significance only when adjusted for creatinine. Combining exercise capacity and the Child–Pugh classification identified patients at a particularly high mortality risk. Conclusions: In patients with liver cirrhosis outside the liver transplant setting, the impaired six-minute-walking-test-derived distance and peak VO2 serve as predictors of mortality and may help to identify patients at a particularly high mortality risk. These results suggest that functional capacity provides complementary information to established liver disease severity scores and could be considered in a multidimensional risk assessment approach in patients with liver cirrhosis. Full article
(This article belongs to the Special Issue Advancements in the Diagnosis and Management of Liver Disease and Liver Transplantation)
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18 pages, 3425 KB  
Article
All About Multiparametric MRI Evaluation in Biliary Tree Complications After Liver Transplant
by Adrian Dumitru Dijmărescu, Cristina Dumitrescu, Cristina Alexandra Nicolae, Robert Mihai Enache and Ioana Gabriela Lupescu
Diagnostics 2026, 16(1), 93; https://doi.org/10.3390/diagnostics16010093 - 27 Dec 2025
Viewed by 800
Abstract
Background/Objectives: To present, discuss, and illustrate the role of multiparametric magnetic resonance imaging (MPMRI) in the evaluation of biliary tree (BT) complications after liver transplantation (LT) as an integrated part into the multidisciplinary team approach for personalized patients’ treatment. Methods: We [...] Read more.
Background/Objectives: To present, discuss, and illustrate the role of multiparametric magnetic resonance imaging (MPMRI) in the evaluation of biliary tree (BT) complications after liver transplantation (LT) as an integrated part into the multidisciplinary team approach for personalized patients’ treatment. Methods: We retrospectively analyzed the MPMRI findings of 317 patients out of 1080 cases with LT, admitted to the Fundeni Clinical Institute from January 2005 to June 2025, who developed biliary complications. Results: Biliary complications after LT evaluated by MPMRI included anastomotic strictures in 235 cases (74%), intra- or extrahepatic bile leaks/biloma in 56 patients (18%), secondary cholangitis due to pyogenic cholangitis in 91 cases (29%), liver abscesses in 23 patients (7%), BT lithiasis in 27 patients (8.5%), disease recurrence in 26 cases (8%), and extrinsic BT compression in 1 case (0.3%). Conclusions: MPMRI plays a crucial role for the evaluation of BT complications, with the protocol being optimized in correlation with the clinical question or suspicion and with the clinical status of the patient. Full article
(This article belongs to the Special Issue Advancements in the Diagnosis and Management of Liver Disease and Liver Transplantation)
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Review

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18 pages, 1405 KB  
Review
Porto-Pulmonary Hypertension and Hepato-Pulmonary Syndrome: Diagnostic Procedures and Therapeutic Management
by Roberto G. Carbone, Francesco Puppo, Christopher A. Thomas and Vincenzo Savarino
Diagnostics 2025, 15(14), 1821; https://doi.org/10.3390/diagnostics15141821 - 19 Jul 2025
Cited by 1 | Viewed by 4380
Abstract
The common cause of porto-pulmonary hypertension and hepato-pulmonary syndrome is portal hypertension. Porto-pulmonary hypertension (PPHTN) is a form of pulmonary arterial hypertension, and hepato-pulmonary syndrome (HPS) occurs as a consequence of hepatic injury or vascular disorders. Demographic characteristics, pathophysiology, screening, differential diagnosis, and [...] Read more.
The common cause of porto-pulmonary hypertension and hepato-pulmonary syndrome is portal hypertension. Porto-pulmonary hypertension (PPHTN) is a form of pulmonary arterial hypertension, and hepato-pulmonary syndrome (HPS) occurs as a consequence of hepatic injury or vascular disorders. Demographic characteristics, pathophysiology, screening, differential diagnosis, and treatment of both disorders are treated in this review. Oxygen supply and other medical managements combined with vasodilator drugs are adopted for PPHTN and HPS treatment, but these two clinical conditions also represent an indication for liver transplantation. Despite poor evidence, PPHTN is treated as idiopathic pulmonary arterial hypertension. The latter is combined with improved pulmonary hemodynamics permitting lung transplant. Lung transplant improves PPHTN in one-half of patients and has been associated with longer survival in selected patients. However, the risk of the latter procedure can be relevant as it is closely related to PPHTN severity. Large clinical trials and international guidelines may have a predominant role in increasing our knowledge of both PPHNT and HPS and in improving their outcome by favoring an early diagnosis and more accurate treatment. Full article
(This article belongs to the Special Issue Advancements in the Diagnosis and Management of Liver Disease and Liver Transplantation)
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20 pages, 305 KB  
Review
Liver Elastography Methods for Diagnosis of De Novo and Recurrent Hepatocellular Carcinoma
by Razvan Cerban, Speranta Iacob, Carmen Ester, Mihaela Ghioca, Mirela Chitul, Razvan Iacob and Liana Gheorghe
Diagnostics 2025, 15(9), 1087; https://doi.org/10.3390/diagnostics15091087 - 25 Apr 2025
Cited by 1 | Viewed by 2085
Abstract
Hepatocellular carcinoma (HCC), a common consequence of chronic liver disease, ranks among the most prevalent cancers globally and contributes significantly to cancer-related mortality. Liver fibrosis is intimately associated with hepatic function and the likelihood of future HCC occurrence. Despite the fact that liver [...] Read more.
Hepatocellular carcinoma (HCC), a common consequence of chronic liver disease, ranks among the most prevalent cancers globally and contributes significantly to cancer-related mortality. Liver fibrosis is intimately associated with hepatic function and the likelihood of future HCC occurrence. Despite the fact that liver biopsy continues to be the gold standard for diagnosing fibrosis, its utility is hindered by cost and invasiveness, along with patient unease, procedural rejection, and potential adverse effects. Liver elastography has become a leading noninvasive means of assessing tissue stiffness with considerable diagnostic precision. Malignant tumors generally exhibit higher cellularity in comparison to benign ones, resulting in increased stiffness. Elastography techniques capitalize on alterations in tissue elasticity stemming from specific pathological or physiological processes. Technological innovations, such as advanced ultrasound imaging and artificial intelligence (AI)-integrated systems, are paving the way for enhanced diagnostic accuracy and risk prediction. Recent research underscores the potential of elastography in managing HCC patients, presenting novel clinical applications, including prediction of HCC development, differentiation between malignant and benign liver lesions, evaluating treatment response, and forecasting recurrence post-treatment, though certain findings remain contentious. Therefore, this review aims to sum up the latest advancements in liver elastography for HCC patients, outlining its applications while addressing existing limitations and avenues for future progress. Full article
(This article belongs to the Special Issue Advancements in the Diagnosis and Management of Liver Disease and Liver Transplantation)
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