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A Complete Guide to Liver Imaging & Diagnosis

You Just Got Diagnosed. Now What?

You’ve been told you have fatty liver, NASH, fibrosis, or even cirrhosis. Your doctor mentions tests you’ve never heard of: FibroScan, liver elastography, CAP score, MRE, and schedules you for surveillance imaging every six months.

But what do these scans actually show? Why does your FibroScan number matter? What’s the difference between an ultrasound and an MRI? And why does your doctor keep talking about liver cancer screening when you feel perfectly fine?

This book answers all of that, and guides you through what to do in the critical first 72 hours after diagnosis.

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What’s Inside

10 Comprehensive Chapters Covering Every Imaging Test and Procedure

Chapter	What You’ll Learn
0. “Now What?”	The essential post-diagnosis guide: what to do in your first 72 hours, how to process the emotional shock, and immediate actions that matter
1. Ultrasound	How ultrasound detects fatty liver, what “bright liver” means, grading systems, and limitations
2. Elastography Fundamentals	How liver stiffness is measured, what the numbers mean, and when stiffness ≠ fibrosis
3. FibroScan (VCTE)	Complete guide to FibroScan: M vs XL probes, CAP scores, quality criteria, and interpreting your results
4. FibroTouch	Alternative elastography platform commonly used in Asia
5. pSWE & 2D-SWE	Other ultrasound-based elastography options and why results aren’t interchangeable between machines
6. MRI, MRE & PDFF	The gold standard: MR elastography for fibrosis, PDFF for fat quantification, and when MRI is worth the cost
7. HCC Surveillance	Liver cancer screening: why every 6 months, what happens when ultrasound isn’t enough, and NASH-specific challenges
8. Endoscopy & Varices	Everything about variceal screening: what to expect, how to prepare, and treatment options
9. Invasive Procedures	Liver biopsy, HVPG measurement, and paracentesis: when they’re needed and what to expect

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The Chapter That Could Change Everything

Chapter 0: “You Have Fatty Liver, NASH, Fibrosis or Cirrhosis. Now What?”

This isn’t your typical medical chapter. It’s the guide we wish every newly diagnosed patient received:

✅ The Reversibility Table: What can actually improve with lifestyle changes (and realistic timelines)
✅ The 72-Hour Emergency Checklist: Exactly what to do in your first three days
✅ The First-Week Action Plan: Day-by-day implementable steps
✅ Decoding Your Diagnosis: What terms like “F2 fibrosis” or “compensated cirrhosis” actually mean
✅ The Emotional Rollercoaster: Why you feel confused, angry, and scared (and why that’s normal)
✅ 2 a.m. FAQs: Answers to the questions that keep you up at night
✅ Red Flags: When to call emergency services immediately

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Who This Book Is For

✅ Anyone just diagnosed with fatty liver, NASH, or cirrhosis: Start with Chapter 0
✅ Patients scheduled for a FibroScan: Chapters 2-3 explain everything
✅ People with “limited visualization” on ultrasound: Learn about MRI alternatives (Chapters 6-7)
✅ Cirrhosis patients undergoing HCC surveillance: Chapter 7 is essential reading
✅ Anyone facing endoscopy for varices: Chapter 8 walks you through the entire process
✅ Caregivers and family members: Understand what your loved one is going through
✅ Primary care clinicians: Use as a patient education resource

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What Makes This Book Different

Scientifically Rigorous

Every chapter reflects current guidelines: AASLD 2024, EASL-EASD-EASO 2024, Baveno VII. Over 200 peer-reviewed references.

Written in Two Layers

• Technical explanations for those who want the details
• “Understanding in Simple Terms” sections that translate medical jargon into plain English

Clinically Practical

Not just what tests measure, but what to do with the results, including when to push for MRI if ultrasound isn’t adequate.

Emotionally Intelligent

Chapter 0 acknowledges that a liver diagnosis is scary. We address the fear, anger, and confusion; not just the medical facts.

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Sample Topics Covered

From Chapter 0: The Post-Diagnosis Guide

• What’s actually reversible with weight loss (with realistic timelines)
• The single most important behavior change you can make today
• Why “no symptoms” doesn’t mean “nothing to worry about”
• The medication and supplement review that could save your liver

From Chapter 3: FibroScan

• Why probe selection (M vs XL) matters and what happens when the wrong one is used
• How to interpret your CAP score (steatosis measurement)
• What “quality criteria” mean and when to request a repeat scan
• The confounders that can falsely elevate your results

From Chapter 7: HCC Surveillance

• Why ultrasound misses up to 80% of liver cancers in obese patients
• When to ask for MRI or CT instead
• Understanding visualization scores (LI-RADS A, B, C)
• The 6-month schedule and why it matters

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Detailed Table of Contents

Chapter 0: You Have Fatty Liver, NASH, Fibrosis or Cirrhosis. Now What?

• Parameter Reversibility with Lifestyle Interventions (comprehensive table)
• The Terminology That Will Confuse You (NAFLD → MASLD → MAFLD explained)
• Disease Etiology: Why Did This Happen to Me?
• Immediate Red Flags: Call Emergency Care Now
• Tests You Will Likely Be Told You Need
• The Emotional Rollercoaster: Why You Feel Confused, Angry, and Scared
• What You Must Do in the Next 72 Hours
• The First-Week Action Plan (Day 0-7)
• If You Already Have Cirrhosis: The Urgent Checklist
• Quick FAQs Your Panic Will Ask at 2 a.m.
• Appendix: Printable 72-Hour Emergency Checklist

Chapter 1: Abdominal Ultrasound

• Sonographic Findings: Bright Liver, Hepatorenal Contrast, Vascular Blunting
• Grading Systems (Grade 0-3)
• Advanced Techniques: CAP, Attenuation Coefficient, UDFF
• Portal Venous Doppler Assessment
• Advantages and Limitations
• Next Steps in the Diagnostic Pathway

Chapter 2: Fundamentals of Liver Elastography

• The Physics of Liver Elastography (in plain English)
• The Biological Basis of Liver Stiffness
• Categories of Elastography Technology: VCTE, pSWE, 2D-SWE, MRE
• Key Technical Differences Between Modalities
• Universal Acquisition Principles
• Confounders: When Stiffness ≠ Fibrosis
• Clinical Interpretation Framework

Chapter 3: FibroScan® (VCTE)

• How FibroScan Works: The VCTE Principle
• Device Models: 430 Mini+, 530 Compact, 630 Expert
• Probe Selection: S+, M+, XL+ (and why it matters)
• Controlled Attenuation Parameter (CAP) for Steatosis
• Diagnostic Performance by Disease Etiology
• Quality Criteria and Examination Reliability
• Clinical Applications and Monitoring Frequency
• Advantages, Limitations, and Frequently Asked Questions

Chapter 4: FibroTouch

• Technology and Design
• Correlation with FibroScan
• Diagnostic Performance for Fibrosis and Steatosis
• Cut-off Values and Reproducibility

Chapter 5: Alternatives to FibroScan (pSWE & 2D-SWE)

• Overview of Elastography Modalities
• Technical Principles: How Each Technique Generates Shear Waves
• Diagnostic Performance Comparison
• Manufacturer-Specific Systems (Supersonic, GE, Canon, Philips, Samsung, Siemens)
• The Non-Interchangeability Problem
• Clinical Decision Guide: When to Choose Which Modality

Chapter 6: MRI, MRE & PDFF

• MRI Physics Overview (accessible explanation)
• Magnetic Resonance Elastography (MRE): The Most Accurate Fibrosis Test
• Proton Density Fat Fraction (PDFF): The Gold Standard for Liver Fat
• T1 Mapping (cT1) for Inflammation
• Iron Quantification (R2/T2)
• Diffusion-Weighted Imaging (DWI)
• MRI Vendor Ecosystem
• Clinical Use Cases and Limitations
• Frequently Asked Questions

Chapter 7: HCC Surveillance in NASH Cirrhosis

• Current Guidelines: The 6-Month Standard
• Imaging Modalities: Ultrasound vs. CT vs. MRI (comparative performance)
• The Obesity and NASH Crisis: Why Ultrasound Often Fails
• Biomarkers: AFP, GALAD Score, Next-Generation Panels
• Evidence-Based Strategies for Obese NASH Patients
• Safety Considerations for Repeated Contrast Administration
• Protocol Selection Algorithm
• Special Populations: Elderly, CKD, Post-Treatment

Chapter 8: Endoscopy and Varices

• How Cirrhosis Leads to Varices
• Types and Grading of Varices
• The Role of Endoscopy: When It Is (and Isn’t) Needed
• Preparing for Your Endoscopy
• What Happens During the Procedure (step-by-step)
• Understanding Your Results
• Treatment Options: Beta-Blockers vs. Banding
• Living Well Between Endoscopies

Chapter 9: Invasive Procedures

• Liver Biopsy: Indications, Types (Percutaneous vs. Transjugular), Risks
• Hepatic Venous Pressure Gradient (HVPG): The Portal Pressure Gold Standard
• Paracentesis: Diagnostic and Therapeutic
• SAAG Interpretation

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Frequently Asked Questions

Q: Do I need to read Book 1 first?
A: No. Book 2 stands alone. However, if you want to understand your blood tests (ALT, AST, FIB-4, MELD), Book 1 covers those in detail. Together, they provide complete coverage.

Q: Is this book too technical for a non-medical person?
A: No. Every section includes “Understanding in Simple Terms” explanations written specifically for patients. The technical detail is there if you want it, but you don’t need a medical degree to benefit.

Q: I just got diagnosed. Which chapter should I read first?
A: Start with Chapter 0. It’s specifically designed for the overwhelming first days after diagnosis.

Q: My ultrasound says “limited visualization.” What does that mean?
A: Chapter 7 explains this in detail and what to do about it. Short answer: you may need MRI or CT for adequate liver cancer screening.

Q: Will this replace my doctor’s advice?
A: No. This book helps you understand your tests and procedures so you can have more informed conversations with your healthcare team.

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About the Series

A Complete Guide to Liver Imaging & Diagnosis is Book 2 of the Liver Health Series.

Book	Title	Status
Book 1	A Complete Guide to Liver Blood Tests	✅ Available
Book 2	A Complete Guide to Liver Imaging & Diagnosis (This Book)	✅ Available

How the Books Work Together

Book 1: “Your tests are abnormal: what do these numbers mean?”
↓
Book 2: “Now what? What scans do you need? What does diagnosis mean?”

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Already Own Book 1?

Book 2 is the natural next step. Book 1 explained your blood tests. Book 2 explains your imaging, diagnosis, and what to do next.

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