Technology Insight: noninvasive assessment of liver fibrosis by biochemical scores and elastography

Although histopathological analysis of liver tissue is still the reference standard for the evaluation of disease progression in patients with chronic liver disease, a distinct change in clinical practice is occurring. The tendency to substitute histopathological analysis of liver biopsies with complex, surrogate 'noninvasive' measures of disease progression has grown to such a level that clarification and guidance on their use is needed. This Review provides an overview of the proposed noninvasive diagnostic methodologies and their possible integration with the standard invasive procedures used for the evaluation of disease progression (i.e. liver biopsy and the measurement of portal pressure). A concise analysis of what has been proposed for the differentiation of simple fatty liver from nonalcoholic steatohepatitis and its possible fibrogenic evolution is also included. In particular, the Review focuses on the methods easily available as part of daily clinical practice in hepatology--biochemical markers and transient elastography (i.e. liver stiffness measurement).