title: Non-invasive diagnosis of hepatitis B virus-related cirrhosis.
abstract: Chronic hepatitis B (CHB) infection is a major public health problem associated with significant morbidity and mortality worldwide. Twenty-three percent of patients with CHB progress naturally to liver cirrhosis, which was earlier thought to be irreversible. However, it is now known that cirrhosis can in fact be reversed by treatment with oral anti-nucleotide drugs. Thus, early and accurate diagnosis of cirrhosis is important to allow an appropriate treatment strategy to be chosen and to predict the prognosis of patients with CHB. Liver biopsy is the reference standard for assessment of liver fibrosis. However, the method is invasive, and is associated with pain and complications that can be fatal. In addition, intra- and inter-observer variability compromises the accuracy of liver biopsy data. Only small tissue samples are obtained and fibrosis is heterogeneous in such samples. This confounds the two types of observer variability mentioned above. Such limitations have encouraged development of non-invasive methods for assessment of fibrosis. These include measurements of serum biomarkers of fibrosis; and assessment of liver stiffness via transient elastography, acoustic radiation force impulse imaging, real-time elastography, or magnetic resonance elastography. Although significant advances have been made, most work to date has addressed the diagnostic utility of these techniques in the context of cirrhosis caused by chronic hepatitis C infection. In the present review, we examine the advantages afforded by use of non-invasive methods to diagnose cirrhosis in patients with CHB infections and the utility of such methods in clinical practice.
authors.affiliation: Sangheun Lee, Do Young Kim, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Sangheun
authors.initials: S
authors.lastname: Lee
authors.affiliation: Sangheun Lee, Do Young Kim, Department of Internal Medicine, Yonsei University College of Medicine, Seoul 120-752, South Korea.
authors.forename: Do Young
authors.initials: DY
authors.lastname: Kim
mesh_terms: D015415:Biomarkers / Q000097:blood*; D001706:Biopsy; D003952:Diagnostic Imaging / Q000379:methods*; D054459:Elasticity Imaging Techniques; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D008099:Liver / Q000378:metabolism* / Q000473:pathology*; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000821:virology; D008279:Magnetic Resonance Imaging; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results
chemical_list: D015415:Biomarkers
keywords: Acoustic radiation force impulse imaging; Aspartate aminotransferase to platelet ratio index; Chronic hepatitis B; Chronic liver disease; Cirrhosis; FibroTest; Hepatitis B virus; Liver stiffness measurement; Magnetic resonance elastography; Real-time elastography; Transient elastography