Non-invasive assessment of liver fibrosis

Gui-Qiang Wang. Department of Infectious Diseases & Center for Liver Diseases, Peking University First Hospital, Beijing, China.

Hepatic fibrosis is an important feature of progressive chronic liver diseases, and the prognosis and management of chronic liver diseases depend on the degree of liver fibrosis. Therefore, the assessment of liver fibrosis is crucial for predicting disease progression and for treatment planning, especially for the antiviral treatment in chronic hepatitis B. Liver biopsy is the current gold standard for the diagnosis of liver fibrosis, but is an invasive and cannot be repeated often and difficult to be accepted by both physicians and patients. Some alternative non-invasive methods have been developed, including serum markers with different models such as Fibrotest and Fibrometer, the transient elastography (Fibroscan), Magnetic resonance (MR) elastography, and ultrasound elastography. Fibrotest and Fibrometer and other direct and indirect serum markers can predict the presence of significant fibrosis or cirrhosis in patients with chronic liver disease with considerable accuracy. Transient elastography is a new method for the evaluation of liver stiffness based on changes in tissue elasticity induced by hepatic fibrosis and is a noninvasive, reproducible and reliable method to assess hepatic fibrosis as well as to diagnose liver cirrhosis. Magnetic resonance (MR) elastography, a technique for quantitatively assessing the mechanical properties of soft tissues, has shown a safe, noninvasive technique with excellent diagnostic accuracy for assessing hepatic fibrosis. It seems that all non-invasive assessment of liver fibrosis have a good diagnostic accuracy to discriminate patients with mild fibrosis to those with severe fibrosis, but for intermediate stages of liver fibrosis show discordance. A combination of different measurement may improve the diagnostic accuracy and the new non-invasive markers need to be developed.