Measuring Fibrosis: Is Seeing Really Believing?

Excerpt

Chronic liver disease is a rising global health problem. However, despite vast advances in medical technology, liver biopsy remains the gold standard in assessing disease severity [1]. Biopsy was historically utilized solely for diagnostic purposes; however, with the advent of therapeutic options, biopsy is now additionally utilized in therapeutic decision making and determining prognosis. However, the procedure itself is not without complications and limitations, and patients are reluctant to undergo multiple biopsies during treatment. This has fueled efforts in developing non-invasive methods to measure fibrosis. Early detection of fibrosis allows for identification of patients who require therapy to prevent evolution to cirrhosis. In a recent systematic review by Smith and Sterling [2], non-invasive methods (clinical demographics, serum biomarkers, imaging modalities, breath tests, and complex models) used either alone or in combination were reported. Many non-invasive measures are shown to detect cirrhosis, but are not established in differentiating between stages of fibrosis. Each seems to have its own advantages and disadvantages. Of the imaging techniques, ultrasound holds the most promise due to its widespread availability. …