Non-invasive evaluation of patients with viral hepatitis

Liver fibrosis evaluation is essential in patients with chronic viral liver disease with major impact on treatment decisions. Liver biopsy is still considered the "gold-standard", but it is an invasive method, non-totally risk free, not very well accepted by patients, and unsuitable for regular follow-up examinations. In the last 10-15 years, several non-invasive methods for liver fibrosis assessment were developed: serological tests (simple or complex), ultrasound based elastographic methods (which can be classified in shear wave elastography methods and strain elastography methods) and magnetic resonance elastography. Today in clinical practice, ultrasound based elastographic methods are mostly used. From this category of methods, the oldest and more used is transient elastography, which was included also in several guidelines for assessing liver fibrosis in chronic hepatitis B and C patients. Each method has his advantages and weakness and today there is no consensus regarding which method should be considered the best "surrogate" for liver biopsy. Here we will try to give a comprehensive overview about the different techniques and depict the advantages and disadvantages of each of these methods.