title: Current status of fibrosis markers.
abstract: OBJECTIVE
  Improved understanding of the pathophysiology of fibrosis and recent technological advances have resulted in the development of several serum biomarkers and imaging tools as noninvasive alternatives to biopsy. Most of these markers have been developed in chronic hepatitis C (CHC) and nonalcoholic fatty liver disease (NAFLD) patients. This review highlights some of the recent advances and potential clinical application of these modalities.
  
  
  RESULTS
  Many noninvasive approaches initially developed for binary disease staging in CHC continue to be refined for diagnostic use in other chronic liver disease such as NAFLD. A combination of serum markers and imaging tools appears useful in reducing the need for biopsy for the diagnosis of cirrhosis, and providing functional assessment in advanced stage disease. Cytokeratin-18 fragments, controlled attenuation parameter (CAP), real-time elastography, and magnetic resonance imaging approaches appear promising for NAFLD, but require further validation.
  
  
  CONCLUSIONS
  Current noninvasive tests of fibrosis provide good diagnostic and prognostic utility for advanced stage liver disease, and have been adapted into clinical practice for CHC. Reliable biomarkers for steatosis, nonalcoholic steatohepatitis, and assessment of fibrosis progression in chronic liver disease are still required. Continued advances in bioimaging and functional genomics will be important for quantitative assessment of fibrosis and future biomarker development.
authors.affiliation: aDuke Clinical Research Institute, Duke University, Durham, North Carolina, USA bLiver Cell Biology, Centenary Institute, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Keyur
authors.initials: K
authors.lastname: Patel
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Shackel
mesh_terms: D015415:Biomarkers / Q000097:blood*; D001706:Biopsy; D018450:Disease Progression; D054459:Elasticity Imaging Techniques / Q000379:methods; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis*; D065626:Non-alcoholic Fatty Liver Disease / Q000175:diagnosis; D011379:Prognosis
chemical_list: D015415:Biomarkers