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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 7, 2015; 21(41): 11567-11583
Published online Nov 7, 2015. doi: 10.3748/wjg.v21.i41.11567
Non-invasive diagnosis of liver fibrosis and cirrhosis
Yoav Lurie, Muriel Webb, Ruth Cytter-Kuint, Shimon Shteingart, Gerardo Z Lederkremer
Yoav Lurie, Liver Unit, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem 91031, Israel
Muriel Webb, Liver Unit, Department of Gastroenterology, Tel Aviv Medical Center, Tel Aviv 69978, Israel
Ruth Cytter-Kuint, Radiology Department, Shaare Zedek Medical Center, Jerusalem 91031, Israel
Shimon Shteingart, Digestive Disease Institute, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem 91031, Israel
Gerardo Z Lederkremer, Department of Cell Research and Immunology, George Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv 69978, Israel
Author contributions: All authors contributed to this manuscript.
Conflict-of-interest statement: The authors have no conflict of interest to report.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Yoav Lurie, MD, Liver Unit, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem 91031, Israel. yoav@szmc.org.il
Telephone: +972-2-6555035 Fax: +972-2-6555359
Received: April 28, 2015
Peer-review started: May 7, 2015
First decision: June 26, 2015
Revised: July 23, 2015
Accepted: September 15, 2015
Article in press: September 15, 2015
Published online: November 7, 2015
Abstract

The evaluation and follow up of liver fibrosis and cirrhosis have been traditionally performed by liver biopsy. However, during the last 20 years, it has become evident that this “gold-standard” is imperfect; even according to its proponents, it is only “the best” among available methods. Attempts at uncovering non-invasive diagnostic tools have yielded multiple scores, formulae, and imaging modalities. All are better tolerated, safer, more acceptable to the patient, and can be repeated essentially as often as required. Most are much less expensive than liver biopsy. Consequently, their use is growing, and in some countries the number of biopsies performed, at least for routine evaluation of hepatitis B and C, has declined sharply. However, the accuracy and diagnostic value of most, if not all, of these methods remains controversial. In this review for the practicing physician, we analyze established and novel biomarkers and physical techniques. We may be witnessing in recent years the beginning of the end of the first phase for the development of non-invasive markers. Early evidence suggests that they might be at least as good as liver biopsy. Novel experimental markers and imaging techniques could produce a dramatic change in diagnosis in the near future.

Keywords: Liver, Fibrosis, Cirrhosis, Non-invasive, Serum biomarkers, Ultrasonography, Computerized tomography, Magnetic resonance imaging

Core tip: Liver fibrosis (leading to liver cirrhosis), and not inflammation and cytolysis, is the main cause of liver disease-associated morbidity and mortality. During the last 20 years, it has become evident, even to its proponents that liver biopsy, is no longer the “gold-standard”. At most, it is the old standard. Non-invasive diagnostic scores, formulae, and imaging modalities, all of which can be repeated as often as required, are cheaper, better tolerated, safer, and more acceptable to the patient than liver biopsy. Although their accuracy is still controversial, early evidence indicates that they might be at least as good as liver biopsy.