title: Systematic review: non-invasive methods of fibrosis analysis in chronic hepatitis C.
abstract: BACKGROUND
  Accurate determination of the presence and degree of liver fibrosis is essential for prognosis and for planning treatment of patients with chronic hepatitis C virus (HCV). Non-invasive methods of assessing fibrosis have been developed to reduce the need for biopsy.
  
  
  OBJECTIVE
  To perform a review of these non-invasive measures and their ability to replace biopsy for assessing hepatic fibrosis in patients with chronic HCV.
  
  
  METHODS
  A systematic review of PUBMED and EMBASE was performed through 2008 using the following search terms: HCV, liver, elastography, hepatitis, Fibroscan, SPECT, noninvasive liver fibrosis, ultrasonography, Doppler, MRI, Fibrotest, Fibrosure, Actitest, APRI, Forns and breath tests, alone or in combination.
  
  
  RESULTS
  We identified 151 studies: 87 using biochemical, 57 imaging and seven breath tests either alone or in combination.
  
  
  CONCLUSIONS
  Great strides are being made in the development of accurate non-invasive methods for determination of fibrosis. Although no single non-invasive test or model developed to date can match that information obtained from actual histology (i.e. inflammation, fibrosis, steatosis), combinations of two modalities of non-invasive methods can reliably differentiate between minimal and significant fibrosis, and thereby avoid liver biopsy in a significant percentage of patients.
authors.affiliation: Division of Gastroenterology, Hepatology, and Nutrition, Virginia Commonwealth University Health System, Richmond, VA 23298-0341, USA.
authors.forename: J O
authors.initials: JO
authors.lastname: Smith
authors.forename: R K
authors.initials: RK
authors.lastname: Sterling
mesh_terms: D000367:Age Factors; D015415:Biomarkers; D003952:Diagnostic Imaging / Q000379:methods*; D003955:Diagnostic Tests, Routine / Q000379:methods*; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000209:etiology; D012737:Sex Factors
chemical_list: D015415:Biomarkers