The objective was to assess the clinical usefulness of high resolution ultrasound (US) analysis of the liver surface for the diagnosis of cirrhosis. In a prospective study, US evaluation of the ventral contour of the liver was performed using a 7.5 MHz linear transducer in 100 patients with suspected liver disease. Only reproducible diffuse ventral liver surface irregularities were considered as an objective US sign of cirrhosis. All patients underwent liver biopsy and/or laparoscopy in order to obtain a definitive diagnosis. Disease prevalence for cirrhosis was 49%. In nine cases the visualized US irregularities were both unconvincing and hardly reproducible. Consequently, they were considered as non-diagnostic and excluded from further analysis. On 91 diagnostic studies, the sensitivity of US for cirrhosis was 91.1%, the specificity 93.5% and the accuracy 92.3%. Positive and negative predictive values were 93.2% and 91.5%, respectively. Provided non-diagnostic cases were considered as technically satisfactory studies and included as true-positive and false-positive cases, this would slightly increase the sensitivity but decrease specificity and accuracy to 91.8%, 84.3%, and 88.0%, respectively. High resolution US analysis of the ventral liver contour is a clinically reliable non-invasive test for the diagnosis of cirrhosis.