title: Non invasive tools for the diagnosis of liver cirrhosis.
abstract: Liver cirrhosis (LC), the end stage of many forms of chronic hepatitis of different etiologies is a diffuse process characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules surrounded by annular fibrosis. This chronic progressive clinical condition, leads to liver cell failure and portal hypertension, which can favour the onset of hepatocellular carcinoma. Defining the phase of the natural history is crucial for therapeutic choice and prognosis. Liver biopsy is currently considered the best available standard of reference but it has some limits, so alternative tools have been developed to substitute liver biopsy when assessing liver fibrosis. Serum markers offer a cost-effective alternative to liver biopsy being less invasive and theoretically without complications. They can be classified into direct and indirect markers which may be used alone or in combination to produce composite scores. Diagnostic imaging includes a number of instruments and techniques to estimate liver fibrosis and cirrhosis like ultrasound (US), US Doppler, contrast enhanced US and Elastography. US could be used for the diagnosis of advanced LC while is not able to evaluate progression of fibrosis, in this case Elastography is more reliable. This review aims to revise the most recent data from the literature about non invasive methods useful in defining liver fibrosis.
authors.affiliation: Maurizio Soresi, Lydia Giannitrapani, Anna Licata, Giuseppe Montalto, Unit of Internal Medicine, Biomedical Department of Internal Medicine and Specialties DiBiMIS, University of Palermo, 90127 Palermo, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Soresi
authors.affiliation: Maurizio Soresi, Lydia Giannitrapani, Anna Licata, Giuseppe Montalto, Unit of Internal Medicine, Biomedical Department of Internal Medicine and Specialties DiBiMIS, University of Palermo, 90127 Palermo, Italy.
authors.forename: Lydia
authors.initials: L
authors.lastname: Giannitrapani
authors.affiliation: Maurizio Soresi, Lydia Giannitrapani, Anna Licata, Giuseppe Montalto, Unit of Internal Medicine, Biomedical Department of Internal Medicine and Specialties DiBiMIS, University of Palermo, 90127 Palermo, Italy.
authors.forename: Melchiorre
authors.initials: M
authors.lastname: Cervello
authors.affiliation: Maurizio Soresi, Lydia Giannitrapani, Anna Licata, Giuseppe Montalto, Unit of Internal Medicine, Biomedical Department of Internal Medicine and Specialties DiBiMIS, University of Palermo, 90127 Palermo, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Licata
authors.affiliation: Maurizio Soresi, Lydia Giannitrapani, Anna Licata, Giuseppe Montalto, Unit of Internal Medicine, Biomedical Department of Internal Medicine and Specialties DiBiMIS, University of Palermo, 90127 Palermo, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Montalto
mesh_terms: D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D003287:Contrast Media; D003952:Diagnostic Imaging / Q000379:methods*; D054459:Elasticity Imaging Techniques; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D018608:Ultrasonography, Doppler
chemical_list: D015415:Biomarkers; D003287:Contrast Media
keywords: Elastography; Liver biopsy; Liver fibrosis; Serum markers; Ultrasound