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Technology Insight: noninvasive assessment of liver fibrosis by biochemical scores and elastography

Nature Clinical Practice Gastroenterology & Hepatology volume 5, pages 95–106 (2008)Cite this article

Abstract

Although histopathological analysis of liver tissue is still the reference standard for the evaluation of disease progression in patients with chronic liver disease, a distinct change in clinical practice is occurring. The tendency to substitute histopathological analysis of liver biopsies with complex, surrogate 'noninvasive' measures of disease progression has grown to such a level that clarification and guidance on their use is needed. This Review provides an overview of the proposed noninvasive diagnostic methodologies and their possible integration with the standard invasive procedures used for the evaluation of disease progression (i.e. liver biopsy and the measurement of portal pressure). A concise analysis of what has been proposed for the differentiation of simple fatty liver from nonalcoholic steatohepatitis and its possible fibrogenic evolution is also included. In particular, the Review focuses on the methods easily available as part of daily clinical practice in hepatology—biochemical markers and transient elastography (i.e. liver stiffness measurement).

Key Points

  • Several noninvasive approaches—serum markers, transient elastography and imaging—have been proposed as a replacement for, or accompaniment to, histopathological analysis of liver biopsies for the assessment of liver fibrosis

  • All proposed noninvasive methodologies have sufficient-to-excellent diagnostic accuracy for the detection (or exclusion) of advanced fibrosis and cirrhosis, but none allow a step-wise follow-up of the fibrogenic evolution of chronic liver disease according to the existing histopathological staging systems; in addition, none of the currently available tests has a well-defined prognostic value, such as the prediction of decompensation or death

  • Due to 'spectrum bias' and the possible causes of discordance with the histopathological assessment, applying the different proposed cut-off values in clinical practice is currently hazardous

  • Combining two unrelated noninvasive tests (i.e. a biochemical test and liver stiffness measurement) might be useful for the initial assessment of fibrosis evolution in patients with chronic liver disease

  • Most noninvasive methods could be instrumental in staging advanced fibrosis from F3/F4 and beyond

  • A noninvasive approach to NAFLD would need to differentiate NASH from bland steatosis in addition to detecting clinically relevant fibrosis and monitoring disease progression

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Figure 1: Proposed algorithm for the noninvasive assessment of fibrosis evolution in patients with chronic hepatitis C.

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Acknowledgements

We are indebted to the reviewers of this article, who directed our attention to several relevant issues and controversies still present in this complex area of clinical investigation.

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Authors and Affiliations

  1. M Pinzani is Professor of Medicine and responsible for Unit 6 (Hepatology), and F Marra is Associate Professor of Medicine, Center for Research, High Education and Transfer DENOThe, Università degli Studi di Firenze, Florence, Italy.,

    Massimo Pinzani & Fabio Marra

  2. Dipartimento di Medicina Interna at the Università degli Studi di Firenze., F Vizzutti is a Gastroenterology Specialist and in charge of the Hepatic Hemodynamic Laboratory, and U Arena is a Gastroenterology Specialist and in charge of the Ultrasound Laboratory,

    Francesco Vizzutti & Umberto Arena

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  1. Massimo Pinzani
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  2. Francesco Vizzutti
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Correspondence to Massimo Pinzani.

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Pinzani, M., Vizzutti, F., Arena, U. et al. Technology Insight: noninvasive assessment of liver fibrosis by biochemical scores and elastography. Nat Rev Gastroenterol Hepatol 5, 95–106 (2008). https://doi.org/10.1038/ncpgasthep1025

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