title: Non-invasive diagnosis of liver fibrosis and cirrhosis.
abstract: The evaluation and follow up of liver fibrosis and cirrhosis have been traditionally performed by liver biopsy. However, during the last 20 years, it has become evident that this "gold-standard" is imperfect; even according to its proponents, it is only "the best" among available methods. Attempts at uncovering non-invasive diagnostic tools have yielded multiple scores, formulae, and imaging modalities. All are better tolerated, safer, more acceptable to the patient, and can be repeated essentially as often as required. Most are much less expensive than liver biopsy. Consequently, their use is growing, and in some countries the number of biopsies performed, at least for routine evaluation of hepatitis B and C, has declined sharply. However, the accuracy and diagnostic value of most, if not all, of these methods remains controversial. In this review for the practicing physician, we analyze established and novel biomarkers and physical techniques. We may be witnessing in recent years the beginning of the end of the first phase for the development of non-invasive markers. Early evidence suggests that they might be at least as good as liver biopsy. Novel experimental markers and imaging techniques could produce a dramatic change in diagnosis in the near future.
authors.affiliation: Yoav Lurie, Liver Unit, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem 91031, Israel.
authors.forename: Yoav
authors.initials: Y
authors.lastname: Lurie
authors.affiliation: Yoav Lurie, Liver Unit, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem 91031, Israel.
authors.forename: Muriel
authors.initials: M
authors.lastname: Webb
authors.affiliation: Yoav Lurie, Liver Unit, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem 91031, Israel.
authors.forename: Ruth
authors.initials: R
authors.lastname: Cytter-Kuint
authors.affiliation: Yoav Lurie, Liver Unit, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem 91031, Israel.
authors.forename: Shimon
authors.initials: S
authors.lastname: Shteingart
authors.affiliation: Yoav Lurie, Liver Unit, Shaare Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem 91031, Israel.
authors.forename: Gerardo Z
authors.initials: GZ
authors.lastname: Lederkremer
mesh_terms: D015415:Biomarkers / Q000097:blood; D001706:Biopsy; 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; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D011237:Predictive Value of Tests; D011379:Prognosis; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed
chemical_list: D015415:Biomarkers
keywords: Cirrhosis; Computerized tomography; Fibrosis; Liver; Magnetic resonance imaging; Non-invasive; Serum biomarkers; Ultrasonography