The following tests may be used to diagnose primary biliary cirrhosis 1. Laboratory tests: Blood tests to check liver function. Enzyme levels measured by liver function tests can generally indicate the presence of liver disease and specifically reflect the presence of bile duct damage. Blood tests to check for signs of autoimmune disease. Blood analysis reflects the level of anti-mitochondrial antibodies (AMA). This antibody is almost never detected in patients who do not have the disease, even if they also have other liver diseases. Therefore, a positive AMA test result will confirm the presence of the disease with a high degree of certainty. However, in a small number of patients with primary biliary cirrhosis, the blood does not contain AMA. 2. Imaging: Ultrasonography: Ultrasonography uses high-frequency sound waves to generate images of structures in the body. Computed tomography (CT scan): You may have a CT scan, a special X-ray imaging technique that provides more information than standard X-ray imaging. Magnetic resonance imaging (MRI): MRI scanners use magnetic fields and radio waves to produce fine images of organs and tissues. Unlike CT, MRI does not produce radiation. Magnetic resonance elastography (MRE): This new test combines MRI imaging with acoustic wave technology to generate a distribution of elastic coefficients of organs in the body (elastogram): this test determines the presence of cirrhosis by detecting the hardening of the liver, similar to a doctor’s palpation. Bile duct x-ray: In addition to MRI, a bile duct x-ray called endoscopic retrograde cholangiopancreatography (ERCP) may be required as a complementary or alternative test to MRI. In order for the X-ray image to show the bile ducts, the doctor inserts a flexible catheter from the throat to the opening of the bile ducts in the small intestine and injects a contrast medium. This is an interventional test and can lead to complications. With the development of MRI technology, this test is usually no longer necessary. If the diagnosis is still uncertain, the doctor may perform a biopsy. The doctor will remove a small sample of liver tissue through a liver puncture and then perform laboratory tests to determine the diagnosis or the extent of the liver lesion (disease stage). During a biopsy, the doctor uses a fine needle to take a sample of tissue through a small incision.