Assessing Liver Volume as a Prognostic Indicator in Cirrhosis

Abstract

Cirrhosis presents significant obstacles in predicting patient outcomes, highlighting the need for reliable markers to guide clinical decisions. Liver volume, measured using advanced imaging methods such as computed tomography (CT) and magnetic resonance imaging (MRI), provides a structural assessment of liver function that goes beyond traditional blood tests. This review compiles evidence up to March 2025 on liver volume’s role as a prognostic indicator in cirrhosis, exploring its relationships with mortality, hepatic decompensation, and results after procedures like transjugular intrahepatic portosystemic shunt (TIPS) or liver transplantation. Studies consistently show that liver volumes below 800-1000 cm³ are associated with higher risks of death and complications, while the liver-to-spleen volume ratio (LSVR) offers an additional gauge of disease severity.

Despite its clear value, liver volume isn’t yet a standard tool in practice due to varying measurement techniques and a lack of agreed-upon normal ranges. Pairing it with established systems like the Model for End-Stage Liver Disease (MELD) score could sharpen predictions and create a more comprehensive risk evaluation. This review examines how liver volume is measured, its practical implications, and the barriers to its broader use, while pointing to future research directions to boost its role in cirrhosis management. The data suggest that liver volume, as a direct measure of liver health, could complement existing tools, paving the way for earlier interventions and more tailored treatments. To fully realize its potential, though, standardized methods and thorough validation are essential.