vcLiver Fibrosis: Difficulties in Diagnostic and Treatment: A Review

Abstract

Early discovery of liver fibrosis and cirrhosis is becoming more relevant because of enhanced incidence of hepatocellular carcinoma. There a many underlying factors in developing liver fibrosis (i.e. viral hepatitis, steatohepatitis). Diagnosis of liver fibrosis is difficult; chronic liver failure and less distinct fibrosis stages can be underestimated, when laboratory routine parameters and native ultrasound of the liver are unsuspicious. Liver biopsy is a common element of diagnostic workup in hepatic cirrhosis, alongside clinical examination and abdominal ultrasound, and is the accepted diagnostic gold standard. But there is no unitary system of histological classification used to evaluate the degree of fibrosis, and individual systems are often validated only for individual disease entities. On the other hand liver biopsy is of less tolerance for patients. In the last years serological markers for detecting liver fibrosis were developed with different validity. Various imaging modalities have been proposed as methods for assessing liver fibrosis by liver stiffness measurement. They are sufficient to approve the suspicious of liver fibrosis and/or to uncover unknown chronic liver failure. Studies showed the clinical usefulness of acoustic radiation force impulse shear wave elasticity imaging (ARFI-SWEI) is efficient as a preventive screening method to uncover fibrosis. The ARFI-SWEI system is integrated in an ultrasound device has a good accuracy and high reproducibility. Therapy of liver fibrosis depends on underlying disease and degree of liver failure. When liver failure can be cured liver fibrosis can regress. Direct antifibrotic drugs are actually not available but in progress.

TMM: A comprehensive CAD system for hepatic fibrosis 5‐grade METAVIR staging based on liver MRI

“…2 Early fibrosis is considered potentially reversible by the removal of causative agents, while as the end-stage of the pathological process, cirrhosis is considered irreversible and is difficult to treat. 3 Therefore, the early discovery of liver fibrosis and cirrhosis is of great value in the treatment of liver diseases. At present, liver biopsy is the gold standard for assessing fibrosis.However, standard liver biopsy has several limitations, including sampling variability, inter-observer and intra-observer variability, invasiveness, and less tolerance for patients.…”

“…Based on hepatic stiffness assessed through meta‐analysis of histological data in viral hepatitis (METAVIR) score, fibrosis can be divided into five stages: fibrosis (F0), portal fibrous expansion (F1), thin fibrous septa emanating from portal triads (F2), fibrous septa bridging portal triads and central veins (F3), and cirrhosis (F4) 2 . Early fibrosis is considered potentially reversible by the removal of causative agents, while as the end‐stage of the pathological process, cirrhosis is considered irreversible and is difficult to treat 3 . Therefore, the early discovery of liver fibrosis and cirrhosis is of great value in the treatment of liver diseases.…”

Suppression of transforming growth factor-β by mesenchymal stem-cells accelerates liver regeneration in liver fibrosis animal model

“…Liver fibrosis (LF), a most common chronic liver injury, results from unregulated wound healing. (1,2) Transforming growth factor-beta (TGF-β), a cytokine released by inflammatory cells (for example macrophages), parenchymal cells, and platelets during the healing process, is the main contributor of LF promotion through activation of quiescent hepatic stellate cells (HSCs) into myofibroblasts (MFs). (3) The active MFs are characterized by expression of α-smooth muscle actin (α-SMA) and increased synthesis of the extracellular matrix (ECM) such as collagen, potentially inducing scar tissue development.…”