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World J Gastroenterol. Dec 28, 2014; 20(48): 18131-18150
Published online Dec 28, 2014. doi: 10.3748/wjg.v20.i48.18131
Non invasive tools for the diagnosis of liver cirrhosis
Maurizio Soresi, Lydia Giannitrapani, Melchiorre Cervello, Anna Licata, Giuseppe Montalto
Maurizio Soresi, Lydia Giannitrapani, Anna Licata, Giuseppe Montalto, Unit of Internal Medicine, Biomedical Department of Internal Medicine and Specialties DiBiMIS, University of Palermo, 90127 Palermo, Italy
Melchiorre Cervello, Giuseppe Montalto, Institute of Biomedicine and Molecular Immunology “A. Monroy”, National Research Council (CNR), 90146 Palermo, Italy
Author contributions: Giannitrapani L and Licata A collected and analyzed literature data; Soresi M contributed analytics tools; Montalto G and Cervello M supervised the paper; Soresi M and Giannitrapani L wrote the paper.
Correspondence to: Giuseppe Montalto, Professor, Biomedical Department of Internal Medicine and Specialties DiBiMIS, University of Palermo, via del Vespro 141, 90127 Palermo, Italy.
Telephone: +39-91-6552991 Fax: +39-91-6552977
Received: July 25, 2014
Revised: September 22, 2014
Accepted: November 7, 2014
Published online: December 28, 2014

Liver cirrhosis (LC), the end stage of many forms of chronic hepatitis of different etiologies is a diffuse process characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules surrounded by annular fibrosis. This chronic progressive clinical condition, leads to liver cell failure and portal hypertension, which can favour the onset of hepatocellular carcinoma. Defining the phase of the natural history is crucial for therapeutic choice and prognosis. Liver biopsy is currently considered the best available standard of reference but it has some limits, so alternative tools have been developed to substitute liver biopsy when assessing liver fibrosis. Serum markers offer a cost-effective alternative to liver biopsy being less invasive and theoretically without complications. They can be classified into direct and indirect markers which may be used alone or in combination to produce composite scores. Diagnostic imaging includes a number of instruments and techniques to estimate liver fibrosis and cirrhosis like ultrasound (US), US Doppler, contrast enhanced US and Elastography. US could be used for the diagnosis of advanced LC while is not able to evaluate progression of fibrosis, in this case Elastography is more reliable. This review aims to revise the most recent data from the literature about non invasive methods useful in defining liver fibrosis.

Keywords: Liver fibrosis, Liver biopsy, Ultrasound, Elastography, Serum markers

Core tip: Liver biopsy is the current best available standard of reference to diagnose liver fibrosis, but it has several limits. Non-invasive methods to detect and follow up liver fibrosis (direct and indirect serum markers, ultrasound, ultrasound doppler, contrast enhanced ultrasound and Elastography) have been extensively studied in the last years but strong evidences of their usefulness in the real practice are still lacking. This work aims to review the most recent literature about the use of these non-invasive markers in defining liver fibrosis.