Non invasive tools for the diagnosis of liver cirrhosis

Abstract

Liver cirrhosis (LC), the end stage of many forms of chronic hepatitis of different etiologies is a diffuse process characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules surrounded by annular fibrosis. This chronic progressive clinical condition, leads to liver cell failure and portal hypertension, which can favour the onset of hepatocellular carcinoma. Defining the phase of the natural history is crucial for therapeutic choice and prognosis. Liver biopsy is currently considered the best available standard of reference but it has some limits, so alternative tools have been developed to substitute liver biopsy when assessing liver fibrosis. Serum markers offer a cost-effective alternative to liver biopsy being less invasive and theoretically without complications. They can be classified into direct and indirect markers which may be used alone or in combination to produce composite scores. Diagnostic imaging includes a number of instruments and techniques to estimate liver fibrosis and cirrhosis like ultrasound (US), US Doppler, contrast enhanced US and Elastography. US could be used for the diagnosis of advanced LC while is not able to evaluate progression of fibrosis, in this case Elastography is more reliable. This review aims to revise the most recent data from the literature about non invasive methods useful in defining liver fibrosis.

Prediction of liver cirrhosis, using diagnostic imaging tools

“…The most indicative finding of liver cirrhosis was nodular surface, which was more sensitive on the undersurface of the liver than the superior surface (86% vs 53%) (Figure 3). It was also more sensitive in a high frequency probe [11][12][13] . Although any single US feature had limited sensitivity or specificity in detecting cirrhosis, improvements could be achieved by combining two or three parameters.…”

“…Studies showed an overall sensitivity to chronic liver disease of 65%-95%, with a positive predictive value of 98% [11][12][13] . The most indicative finding of liver cirrhosis was nodular surface, which was more sensitive on the undersurface of the liver than the superior surface (86% vs 53%) (Figure 3).…”

A study on new method of noninvasive esophageal venous pressure measurement based on the airflow and laser detection technology

“…Therefore, for high-risk population of esophageal variceal bleeding in cirrhotic patients, how to effectively and timely make diagnoses and thus predict the probability of bleeding in advance would be particularly important. Since the 1950s, numerous studies have demonstrated that too high esophageal variceal pressure could directly cause esophageal variceal bleeding [3][4][5]. By means of endoscopy, there are two methods of measuring esophageal variceal pressure at present; specifically, one is to measure the intravenous pressure through variceal puncture and the other is performed non-invasively outside the vein [6].…”

Editorial: A New Spin on Magnetic Resonance Elastography

“…Several serum markers have been developed, such as the aspartate aminotransferase to platelet ratio index (APRI) ( 1,2 ), FIB-4 ( 3,4 ), and Fibrosure ( 5,6 ). However, these tests seem to work best at the extremes (no fi brosis and cirrhosis) leaving a signifi cant proportion with indeterminate results (7)(8)(9). Newer imaging techniques that measure liver elastography (stiff ness) as a surrogate of fi brosis seem to outperform serum tests and are increasingly used in clinical practice ( 10 ).…”