Objective To investigate the validity of ultrasonic index (USI) in detecting compensated hepatitis B cirrhosis and the improvement of detecting cirrhosis by stepwise combination of transient elastography (TE) and USI.Methods Total of 222 patients with compensated hepatitis B undergone liver biopsies were retrospectively investigated.Patients' hematology,serum biochemical index,coagulation index,TE and ultrasonography of liver,gallbladder and spleen were statistically analyzed to evaluate the diagnostic efficiency.Results There were statistical differences between patients with and without cirrhosis in age,serum bilirubin,international normalized ratio,platelet,liver stiffness and USI,which could efficiently detect cirrhosis.Among them,TE and USI discriminated cirrhosis with higher area under ROCs without statistical difference [0.896(0.855-0.937) vs 0.852(0.793-0.911),Z =1.30,P =0.1936].While TE classified 65.8％ of patients as cirrhosis or non-cirrhosis and freed them from liver biopsies,this number decreased to 41.9％ in USI,stepwise combination of TE and USI improved this number up to 78.0％.Conclusions USI consisting of age and ultrasonography of liver,gallbladder and spleen was validated to detect cirrhosis with satisfactory efficiency,and could be applied as supplementary non-invasive method to improve performance of TE detecting compensated hepatitis B cirrhosis.