Non-invasive diagnosis of liver fibrosis and cirrhosis
Diagnosis and confirmation of advanced liver fibrosis and cirrhosis are very important in clinical practice to prognosticate and plan therapy accordingly . Over time , non-invasive markers and methods have been developed , which are summarised in this review
KS Prasanna G Balaji Fortis Hospital , Bangalore , India
TABLE 1
METAVIR score 1
Liver fibrosis is an excessive fibrous tissue deposition or scarring in the liver and is the result of a continuous wound-healing process in response to repeated damage . After acute injury , parenchymal cells regenerate to replace the apoptotic / necrotic cells . If the liver injury persists , regeneration eventually fails , and hepatocytes are replaced with a profuse extracellular matrix . Advanced fibrosis eventually progresses to cirrhosis , so early and precise evaluation of severity and status of liver fibrosis provides valuable information for diagnosis as well as for treatment planning and prognosis .
The ‘ gold standard ’ in diagnosis is liver biopsy . However , this is an invasive , uncomfortable and costly procedure that has limitations and complications which , at times , can be life-threatening . Also , biopsy only provides a glimpse , and not a full insight , into the dynamic changes that occur during fibrogenesis and its progression .
Fibrosis is confirmed or quantified with liver histopathology according to the METAVIR score ( Table 1 ).
Consequently , simple , reliable , and non-invasive methods are able to predict the presence of significant fibrosis or cirrhosis in patients with chronic liver disease with significant accuracy are required .
Types of non-invasive diagnostics There are two main non-invasive methods used in diagnosis : 1 . Serum markers 2 . Imaging methods .
Serum markers Liver fibrosis markers are usually divided into indirect and direct markers of fibrogenesis and fibrinolysis .
Direct markers Direct markers of fibrosis include markers associated with matrix deposition , degradation , and cytokines and chemokines associated with the molecular pathogenesis of fibrogenesis and fibrinolysis . Examples include hyaluronic acid , alpha-2- macroglobulin , procollagens , matrix metalloproteinases , transforming growth factors , YKL-40 and laminin ( summarised in Table 2 ).
Limitations of direct serum biomarkers Direct serum biomarkers reflect the rate of matrix turnover
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F0
F1
F2
F3
F4
No fibrosis
Portal fibrosis without septa
Portal fibrosis with few septa
Numerous septa without cirrhosis
Cirrhosis