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Noninvasive assessment of hepatic fibrosis: Overview of serologic and radiographic tests

Authors
Michael P Curry, MD
Nezam H Afdhal, MD, FRCPI
Section Editor
Bruce A Runyon, MD
Deputy Editor
Anne C Travis, MD, MSc, FACG, AGAF

INTRODUCTION

Hepatic fibrosis occurs in response to chronic liver injury. Regardless of the cause, the response to liver injury includes collapse of hepatic lobules, formation of fibrous septae, and hepatocyte regeneration with nodule formation. Extracellular matrix components accumulate in the liver as a result of imbalances in their production, deposition, and degradation. This diffuse process may ultimately progress to cirrhosis, with its accompanying consequences of portal hypertension and impaired hepatic function. (See "Pathogenesis of hepatic fibrosis".)

Hepatic fibrosis was originally thought to be irreversible, but it is now recognized as a dynamic process with the potential for significant resolution. New molecular insights into fibrogenesis and fibrosis regression offer potential targets for antifibrotic therapy and increase the need for noninvasive means to measure changes in fibrosis.

Conventional biochemical and serological tests, when examined alone, are of little value for the assessment of fibrosis. As a result, histopathological examination of a liver biopsy specimen is currently the gold standard for staging hepatic fibrosis. However, a liver biopsy has many limitations. Because it is invasive, it may be associated with complications, and it is usually not welcomed by patients. In addition, it can only sample a small portion of the liver and is thereby susceptible to sampling variation and inter- and intraobserver variability. These issues have led to the development of noninvasive means to estimate the amount of hepatic fibrosis present. (See "Percutaneous, fine-needle aspiration, and laparoscopic liver biopsy".)

This topic will review the serologic and radiographic tests used for the noninvasive assessment of hepatic fibrosis. Ultrasound-based elastography is discussed in more detail separately. The histologic assessment of hepatic fibrosis is discussed elsewhere. (See "Noninvasive assessment of hepatic fibrosis: Ultrasound-based elastography" and "Histologic scoring systems for chronic liver disease".)

STAGES OF FIBROSIS

Noninvasive tests of hepatic fibrosis attempt to predict the stage of hepatic fibrosis that would be seen histologically. There are several histologic scoring systems for chronic liver disease. Many use five-point scales such as the METAVIR score (see "Histologic scoring systems for chronic liver disease", section on 'METAVIR score'):

                           

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