Review
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2016; 22(45): 9880-9897
Published online Dec 7, 2016. doi: 10.3748/wjg.v22.i45.9880
Hepatic steatosis and fibrosis: Non-invasive assessment
Rustam N Karanjia, Mary M E Crossey, I Jane Cox, Haddy K S Fye, Ramou Njie, Robert D Goldin, Simon D Taylor-Robinson
Rustam N Karanjia, Robert D Goldin, Simon D Taylor-Robinson, Mary ME Crossey, Liver Unit, Division of Digestive Health, Department of Surgery and Cancer, Imperial College London, St Mary's Campus, London W2 1NY, United Kingdom
I Jane Cox, Institute of Hepatology London, Foundation for Liver Research, 111 Coldharbour Lane, London SE5 9NT, United Kingdom
I Jane Cox, Faculty of Life Sciences and Medicine, King’s College London, London SE5 9NT, United Kingdom
Ramou Njie, Haddy KS Fye, MRC Gambia, Atlantic Road, Fajara, The Gambia
Author contributions: All authors contributed to this manuscript.
Conflict-of-interest statement: The authors declare no relevant or potential conflicts of interest.
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: Rustam N Karanjia, Liver Unit, Division of Digestive Health, Department of Surgery and Cancer, Imperial College London, St Mary's Campus, 10th Floor QEQM Wing, South Wharf Street, London W2 1NY, United Kingdom. rk2311@ic.ac.uk
Telephone: +44-207-8866454 Fax: +44-207-7249369
Received: September 2, 2016
Peer-review started: September 3, 2016
First decision: September 28, 2016
Revised: October 10, 2016
Accepted: November 15, 2016
Article in press: November 16, 2016
Published online: December 7, 2016
Abstract

Chronic liver disease is a major cause of morbidity and mortality worldwide and usually develops over many years, as a result of chronic inflammation and scarring, resulting in end-stage liver disease and its complications. The progression of disease is characterised by ongoing inflammation and consequent fibrosis, although hepatic steatosis is increasingly being recognised as an important pathological feature of disease, rather than being simply an innocent bystander. However, the current gold standard method of quantifying and staging liver disease, histological analysis by liver biopsy, has several limitations and can have associated morbidity and even mortality. Therefore, there is a clear need for safe and non-invasive assessment modalities to determine hepatic steatosis, inflammation and fibrosis. This review covers key mechanisms and the importance of fibrosis and steatosis in the progression of liver disease. We address non-invasive imaging and blood biomarker assessments that can be used as an alternative to information gained on liver biopsy.

Keywords: Hepatic steatosis, Fibrosis, Non-invasive assessment, Blood biomarker, Ultrasound

Core tip: Ongoing hepatic fibrosis and steatosis are well recognised features of chronic liver disease. Liver biopsy is currently the gold standard for assessing the disease although this has an associated but low morbidity and mortality risk. Therefore, alternative methods of non-invasive assessment of liver disease are of relevance and importance. We outline the mechanisms of hepatic fibrosis and steatosis and review uses of non-invasive imaging and blood biomarkers as an alternative to liver biopsy.