Combining FIB-4 and Liver Stiffness Into the FIB-5, a Single Model that Accurately Predicts Complications of Portal Hypertension

The Past, Present, and Future of Noninvasive Test in Chronic Liver Diseases

Chronic liver disease is a major global health threat and is the 11th leading cause of death globally. A liver biopsy is frequently required in assessing the degree of steatosis and fibrosis, information that is important in diagnosis, management, and prognostication. However, liver biopsies have limitations and carry a considerable risk, leading to the development of various modalities of noninvasive testing tools. These tools have been developed in recent years and have improved markedly in diagnostic accuracy. Moving forward, they may change the practice of hepatology.

Update on the role of elastography in liver disease

The diagnosis of liver fibrosis and the assessment of its severity are important to provide appropriate management, to determine the prognosis or the need for surveillance. Currently, for fibrosis staging, liver stiffness measurement (LSM) with the shear wave elastography (SWE) techniques is considered a reliable substitute for liver biopsy in several clinical scenarios. Nonetheless, it should be emphasized that stiffness value is a biomarker of diffuse liver disease that must be interpreted taking into consideration anamnesis, clinical and laboratory data. In patients with diffuse liver disease, it is more clinically relevant to determine the likelihood of advanced disease rather than to obtain an exact stage of liver fibrosis using a histologic classification. In this regard, a 'rule of five' for LSMs with vibration-controlled transient elastography (VCTE) and a 'rule of four' for LSMs with the acoustic radiation force impulse (ARFI)-based techniques have been proposed. In patients with advanced chronic liver disease (CLD), the risk of liver decompensation increases with increasing liver stiffness value. SWE has been proposed as a tool to predict the risk of death or complications in patients with CLD. LSM by VCTE combined with platelets count is a validated non-invasive method for varices screening, with very good results in terms of invasive procedures being spared. ARFI-based techniques also show some promising results in this setting. LSM, alone or combined in scores or algorithms with other parameters, is used to evaluate the risk of hepatocellular carcinoma occurrence. Due to the high prevalence of CLD, screening the population at risk is of interest but further studies are needed.