title: Non-invasive assessment of liver fibrosis in chronic hepatitis B.
abstract: The goal of this review is to provide a comprehensive picture of the role, clinical applications and future perspectives of the most widely used non-invasive techniques for the evaluation of hepatitis B virus (HBV) infection. During the past decade many non-invasive methods have been developed to reduce the need for liver biopsy in staging fibrosis and to overcome whenever possible its limitations, mainly: invasiveness, costs, low reproducibility, poor acceptance by patients. Elastographic techniques conceived to assess liver stiffness, in particular transient elastography, and the most commonly used biological markers will be assessed against their respective role and limitations in staging hepatic fibrosis. Recent evidence highlights that both liver stiffness and some bio-chemical markers correlate with survival and major clinical end-points such as liver decompensation, development of hepatocellular carcinoma and portal hypertension. Thus the non-invasive techniques here discussed can play a major role in the management of patients with chronic HBV-related hepatitis. Given their prognostic value, transient elastography and some bio-chemical markers can be used to better categorize patients with advanced fibrosis and cirrhosis and assign them to different classes of risk for clinically relevant outcomes. Very recent data indicates that the combined measurements of liver and spleen stiffness enable the reliable prediction of portal hypertension and esophageal varices development.
authors.affiliation: Federica Branchi, Clara Benedetta Conti, Alessandra Baccarin, Dario Conte, Mirella Fraquelli, Second Division of Gastroenterology, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, 20122 Milan, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Branchi
authors.affiliation: Federica Branchi, Clara Benedetta Conti, Alessandra Baccarin, Dario Conte, Mirella Fraquelli, Second Division of Gastroenterology, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, 20122 Milan, Italy.
authors.forename: Clara Benedetta
authors.initials: CB
authors.lastname: Conti
authors.affiliation: Federica Branchi, Clara Benedetta Conti, Alessandra Baccarin, Dario Conte, Mirella Fraquelli, Second Division of Gastroenterology, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, 20122 Milan, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Baccarin
authors.affiliation: Federica Branchi, Clara Benedetta Conti, Alessandra Baccarin, Dario Conte, Mirella Fraquelli, Second Division of Gastroenterology, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, 20122 Milan, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Lampertico
authors.affiliation: Federica Branchi, Clara Benedetta Conti, Alessandra Baccarin, Dario Conte, Mirella Fraquelli, Second Division of Gastroenterology, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, 20122 Milan, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Conte
authors.affiliation: Federica Branchi, Clara Benedetta Conti, Alessandra Baccarin, Dario Conte, Mirella Fraquelli, Second Division of Gastroenterology, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, 20122 Milan, Italy.
authors.forename: Mirella
authors.initials: M
authors.lastname: Fraquelli
mesh_terms: D015415:Biomarkers / Q000097:blood; D018450:Disease Progression; D054459:Elasticity Imaging Techniques / Q000379:methods; D004932:Esophageal and Gastric Varices / Q000821:virology; D019694:Hepatitis B, Chronic / Q000150:complications / Q000175:diagnosis*; D006801:Humans; D006975:Hypertension, Portal / Q000821:virology; D008099:Liver / Q000378:metabolism / Q000473:pathology / Q000821:virology; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000821:virology; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers
keywords: Cirrhosis; Hepatitis B virus; Liver fibrosis; Non invasive markers; Transient elastography