Non-invasive assessment of liver fibrosis and prognosis: an update on serum and elastography markers

ABSTRACT

Introduction: Non-invasive assessment of fibrosis is increasingly utilized in clinical practice to diagnose hepatic fibrosis. Non-invasive assessment of liver fibrosis relies on biologic and/or physical properties to assess tissue fibrosis. Serum markers estimate fibrosis by incorporating markers reflecting hepatic function (indirect markers) and/or markers measuring extracellular matrix degradation/fibrogenesis (direct markers). Radiology based techniques relay the mechanical properties and stiffness of a tissue, with increased stiffness associated with more advanced fibrosis.

Areas covered: In this comprehensive review, the recent literature discussing serum markers and elastography-based techniques will be covered. These modalities are also explored in the setting of various liver diseases.

Expert opinion: The etiology of liver disease and clinical context should be taken into consideration when non-invasive markers are incorporated in clinical practice. Non-invasive assessment of fibrosis has been most extensively utilized in hepatitis C, followed by hepatitis B and nonalcoholic fatty liver disease, but its role remains less developed in other etiologies of liver disease such as alcohol-associated liver disease and autoimmune liver disease. The role of non-invasive markers in predicting progression or regression of fibrosis, development of liver-related events and survival needs to be further explored.

KEYWORDS:

• Elastography
• hepatitis C
• hepatitis B
• liver fibrosis
• liver stiffness
• magnetic resonance elastography
• nonalcoholic fatty liver disease
• shear wave elastography
• vibration-controlled transient elastography

Article highlights

• Serum markers and radiographic imaging utilizing the principle of elastography are well-recognized methods to non-invasively assess liver fibrosis.

• The evidence suggests elastography outperforms serum markers, with VCTE as the most widely utilized method.

• Data evaluating the combination of tests (combined serum or combined serum/imaging tests in either a staged or simultaneous approach) is under intensive investigation, as the combination of tests are complementary and may have better diagnostic accuracy discriminating between stages of fibrosis or ‘intermediate stages’ than a single test alone.

• The increasing global prevalence of NAFLD and associated hepatic complications warrants thorough examination of the most accurate imaging modalities to stage fibrosis in this disease since obesity may limit the reliability or produce unsuccessful tests.

• The utility of elastography in alcoholic liver disease, autoimmune liver disease, HCC, and in the post-transplant setting is undergoing refinement.

• Elastography’s role is evolving to understand how it assists with disease prognostication and fibrosis regression, particularly after therapy or improvement in the underlying liver condition.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was funded by a Baylor Foundation Grant.