Usefulness of Non-Invasive Tools in Liver Fibrosis Assessment

Liver fibrosis occurs as the response of chronic liver injury. In the past, it was thought as irreversible but now is recognized as a dynamic process with possibility of significant resolution. Regardless of the cause, the response to liver injury includes collapse of hepatic lobules, formation of fibrous septae, and hepatocyte regeneration with nodular formation. Conventional biochemical and serological tests have no significant value for assessment of liver fibrosis and liver biopsy specimen is still the "gold standard" for staging of liver diseases. The incessant progress in production of new pharmaceuticals creates an enormous need for non-invasive diagnostics of liver fibrosis. The lack of appropriate non-invasive tools is currently the main limitation for monitoring of disease progression, predicting clinical outcomes and evaluating therapeutic effects. At this time, two groups of diagnostic tools are used for non-invasive assessment of liver fibrosis: imaging techniques and biologically-based markers. Some of them like transient elastogarphy are very promising and others like biologically based markers are helpful but cannot serve as independent markers of liver fibrosis. Therefore, experimental and clinical hepatology of the next decade have a great challenge to find a more accurate, reproducible and non-invasive technique for hepatic fibrosis assessment.