Non invasive assessment of liver fibrosis.

Liver fibrosis is the final common pathway of most chronic liver diseases of various etiologies.The development of fibrosis determines the management policy as well as the prognosis. In recent years it became clear that the fibrotic process is reversible. Therefore early detection of liver fibrosis is critical. At present, liver biopsy is considered the gold standard for the detection of fibrosis. Nevertheless liver biopsy is an invasive procedure limiting both its acceptance by patients, and their compliance for repeated procedures. More over it is a questionable gold standard due to significant sample error and intra and inter observer variability. These limitations have led to the development of noninvasive techniques for assessing the presence and the degree of liver fibrosis, such as biomarkers and transient elastography. The accuracy of these methods as compared to liver biopsy, as well as their use and limitations are reviewed in the article.