Liver Fibrosis Conventional and Molecular Imaging Diagnosis Update

Abstract

Liver fibrosis is a serious, life-threatening disease with high morbidity and mortality that result from diverse causes. Liver biopsy, considered the “gold standard” to diagnose, grade, and stage liver fibrosis, has limitations in terms of invasiveness, cost, sampling variability, inter-observer variability, and the dynamic process of fibrosis. Compelling evidence has demonstrated that all stages of fibrosis are reversible if the injury is removed. There is a clear need for safe, effective, and reliable non-invasive assessment modalities to determine liver fibrosis in order to manage it precisely in personalized medicine. However, conventional imaging methods used to assess morphological and structural changes related to liver fibrosis, including ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI), are only useful in assessing advanced liver disease, including cirrhosis. Functional imaging techniques, including MR elastography (MRE), US elastography, and CT perfusion are useful for assessing moderate to advanced liver fibrosis. MRE is considered the most accurate noninvasive imaging technique, and US elastography is currently the most widely used noninvasive means. However, these modalities are less accurate in early-stage liver fibrosis and some factors affect the accuracy of these techniques. Molecular imaging is a target-specific imaging mechanism that has the potential to accurately diagnose early-stage liver fibrosis. We provide an overview of recent advances in molecular imaging for the diagnosis and staging of liver fibrosis which will enable clinicians to monitor the progression of disease and potentially reverse liver fibrosis. We compare the promising technologies with conventional and functional imaging and assess the utility of molecular imaging in precision and personalized clinical medicine in the early stages of liver fibrosis.

Updates in the quantitative assessment of liver fibrosis for nonalcoholic fatty liver disease: Histological perspective

“…13,41,42 Recent advances in molecular and targeted MR imaging studies of small molecules that bind to fibrillary collagen or other ECM proteins are promising noninvasive approaches in the direct detection and quantification of liver fibrosis that would help overcome some of these limitations. [43][44][45]…”

“…These data are essential in tracking disease progression, prognostication, identifying patients who are most likely to benefit from any therapeutic intervention, and assessing the efficacy of antifibrotic drugs [ 13 , 41 , 42 ]. Recent advances in molecular and targeted MR imaging studies of small molecules that bind to fibrillary collagen or other ECM proteins are promising noninvasive approaches in the direct detection and quantification of liver fibrosis that would help overcome some of these limitations [ 43 - 45 ].…”

The Use of Two-Dimensional Shear Wave Elastography in People with Obesity for the Assessment of Liver Fibrosis in Non-Alcoholic Fatty Liver Disease

“…Angulo et al [ 34 ] suggested that by applying the NAFLD fibrosis score, a liver biopsy to determine the severity of fibrosis can be avoided in approximately 75% of patients with NAFLD. Conventional ultrasonography (US) is the most common technique used for the assessment of morphological and structural changes to the liver in clinical settings [ 35 , 36 ]. Although conventional US is useful in evaluating cirrhosis, it has a lower sensitivity for diagnosing early stages of liver fibrosis [ 37 , 38 ].…”

Advances on Nanomedicines for Diagnosis and Theranostics of Hepatic Fibrosis

“…Unfortunately, a high cost and the complexity of scanning sequences of MRE restrict its use in comparison with USE. [ 41 ] Other imaging methods are helpful in diagnosing and assessing hepatic fibrosis, but they have less applications than elastographs, including diffusion weighted imaging (DWI), [ 42 ] magnetic resonance imaging (MRI) T 1 and T 2 mapping, [ 43 ] MRI perfusion (PWI), [ 44 ] texture analysis (TA), [ 45 ] and susceptibility weighted imaging (SWI). [ 46 ] Indeed, some studies have suggested that these imaging methods, especially MRE, could reach an equivalent or even better efficacy than liver biopsy and they could be used to replace the invasive diagnostic method.…”