Noninvasive tests for liver fibrosis.

The field of noninvasive markers for the assessment of hepatic fibrosis has seen tremendous growth in the last two decades. Surrogate markers are gradually being substituted for biomarkers that reflect the complex balance between synthesis and degradation of the extracellular matrix. Coupled with these promising tests are artificial intelligence networks devised by sophisticated statistical instruments that incorporate a battery of laboratory tests and biomarkers with imaging modalities. Recently, gene identification and protein analysis have shown promise in identifying selected patients with mild or advanced fibrosis. Despite such progress, an important limitation of these tests is the frequent inability to detect mild fibrosis although patients at the end of the histological spectrum (i.e., advanced fibrosis or cirrhosis) are readily identified. With time, it is anticipated a combination of serological and radiological tests together with genetic and proteomic investigations will provide accurate assessment of fibrosis in a cost-effective and timely manner.