The field of hepatic fibrosis enjoys remarkable vitality. As a result, we now have a comprehensive and nuanced portrait of fibrosis progression and regression. In this Review, Scott Friedman provides an update on recent advances in our understanding of the pathways of hepatic fibrosis before considering the key challenges that lie ahead when translating these discoveries into new treatments.

Evolving challenges in hepatic fibrosis

Acoustic Radiation Force Impulse (ARFI) imaging is a novel ultrasound-based elastography method that is integrated in a conventional ultrasound machine enabling the exact localization of measurement site. It might present an alternative method to transient elastography for the noninvasive assessment of liver fibrosis. At present, studies with small patient population have shown promising results. A systematic review and meta-analysis of pooled patient data were performed to evaluate the overall performance of ARFI for the staging of liver fibrosis. Literature databases were searched up to 10/2010. The authors of the original publication were contacted, and the original patient data were requested. A meta-analysis was performed using a random effect meta-analytic method for diagnostic tests. In addition, available data comparing ARFI with FibroScan with the DeLong test were evaluated. Literature search yielded nine full-paper publications evaluating ARFI while using liver biopsy as reference method. Original patient data were available from eight studies including 518 patients. The mean diagnostic accuracy of ARFI expressed as areas under ROC curves (AUROC) was 0.87 for the diagnosis of significant fibrosis (F ≥ 2), 0.91 for the diagnosis of severe fibrosis (F ≥ 3), and 0.93 for the diagnosis of cirrhosis. ARFI can be performed with good diagnostic accuracy for the noninvasive staging of liver fibrosis.

Performance of Acoustic Radiation Force Impulse imaging for the staging of liver fibrosis: a pooled meta-analysis.

The USPSTF now recommends screening for hepatitis C virus (HCV) infection in all asymptomatic persons at high risk for infection and recommends offering 1-time screening for adults born between 194...

/pdf/screening-for-hepatitis-c-virus-infection-in-adults-u-s-4f10nh3qlv.pdf

Screening for Hepatitis C Virus Infection in Adults: U.S. Preventive Services Task Force Recommendation Statement

https://eprints.ncl.ac.uk/file_store/production/185712/79D325E9-AAE3-4F51-AF1C-7D0F5EAFC08C.pdf

Clinical evidence for the regression of liver fibrosis

https://www.journal-of-hepatology.eu/article/S0168-8278(10)00712-9/pdf

Reliability of transient elastography for the detection of fibrosis in non-alcoholic fatty liver disease and chronic viral hepatitis.

Summary

Background Accurate determination of the presence and degree of liver fibrosis is essential for prognosis and for planning treatment of patients with chronic hepatitis C virus (HCV). Non-invasive methods of assessing fibrosis have been developed to reduce the need for biopsy.



Aim  To perform a review of these non-invasive measures and their ability to replace biopsy for assessing hepatic fibrosis in patients with chronic HCV.



Methods  A systematic review of PUBMED and EMBASE was performed through 2008 using the following search terms: HCV, liver, elastography, hepatitis, Fibroscan, SPECT, noninvasive liver fibrosis, ultrasonography, Doppler, MRI, Fibrotest, Fibrosure, Actitest, APRI, Forns and breath tests, alone or in combination.



Results  We identified 151 studies: 87 using biochemical, 57 imaging and seven breath tests either alone or in combination.



Conclusions  Great strides are being made in the development of accurate non-invasive methods for determination of fibrosis. Although no single non-invasive test or model developed to date can match that information obtained from actual histology (i.e. inflammation, fibrosis, steatosis), combinations of two modalities of non-invasive methods can reliably differentiate between minimal and significant fibrosis, and thereby avoid liver biopsy in a significant percentage of patients.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2036.2009.04062.x

Systematic review: non‐invasive methods of fibrosis analysis in chronic hepatitis C

Appropriate evidence‐based data overviews demonstrate the diagnostic and prognostic performances of FibroTest in patients with chronic hepatitis C: authors' reply

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Systematic review: non‐invasive methods of fibrosis analysis in chronic hepatitis C

Appropriate evidence‐based data overviews demonstrate the diagnostic and prognostic performances of FibroTest in patients with chronic hepatitis C: authors' reply