• acoustic radiation force imaging
• chronic liver disease
• hepatic stiffness
• oesophageal varices
• shear wave velocity
• splenic stiffness

• Chronic liver disease
• Esophageal varices
• Shear wave velocity

• JP21fk0210077 Japan Agency for Medical Research and Development

Acoustic radiation force impulse (ARFI) is used to measure liver fibrosis and predict outcomes. The performance of elastography in assessment of fibrosis is poorer in hepatitis B virus (HBV) than in other etiologies of chronic liver disease.

To evaluate the performance of ARFI in long-term outcome prediction among different etiologies of chronic liver disease.

Consecutive patients who received an ARFI study between 2011 and 2018 were enrolled. After excluding dual infection, alcoholism, autoimmune hepatitis, and others with incomplete data, this retrospective cohort were divided into hepatitis B (HBV, n = 1064), hepatitis C (HCV, n = 507), and non-HBV, non-HCV (NBNC, n = 391) groups. The indexed cases were linked to cancer registration (1987-2020) and national mortality databases. The differences in morbidity and mortality among the groups were analyzed.

At the enrollment, the HBV group showed more males (77.5%), a higher prevalence of pre-diagnosed hepatocellular carcinoma (HCC), and a lower prevalence of comorbidities than the other groups (P < 0.001). The HCV group was older and had a lower platelet count and higher ARFI score than the other groups (P < 0.001). The NBNC group showed a higher body mass index and platelet count, a higher prevalence of pre-diagnosed non-HCC cancers (P < 0.001), especially breast cancer, and a lower prevalence of cirrhosis. Male gender, ARFI score, and HBV were independent predictors of HCC. The 5-year risk of HCC was 5.9% and 9.8% for those ARFI-graded with severe fibrosis and cirrhosis. ARFI alone had an area under the receiver operating characteristic curve (AUROC) of 0.742 for prediction of HCC in 5 years. AUROC increased to 0.828 after adding etiology, gender, age, and platelet score. No difference was found in mortality rate among the groups.

The HBV group showed a higher prevalence of HCC but lower comorbidity that made mortality similar among the groups. Those patients with ARFI-graded severe fibrosis or cirrhosis should receive regular surveillance.

• Non-alcoholic fatty liver disease
• Hepatitis B
• Hepatocellular carcinoma
• Acoustic radiation force impulse
• Mortality
• Comorbidity

• Humans
• Male
• Hepatitis B virus
• Retrospective Studies
• Hepatitis C, Chronic/pathology
• Liver Cirrhosis/diagnostic imaging
• Liver Cirrhosis/epidemiology
• Comorbidity
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/epidemiology
• Carcinoma, Hepatocellular/diagnostic imaging
• Carcinoma, Hepatocellular/epidemiology
• Hepatitis C
• Acoustics
• Elasticity Imaging Techniques

This is a protocol for a Cochrane Review (diagnostic). The objectives are as follows:

To assess the diagnostic accuracy of liver stiffness and spleen stiffness, separately or in combination, as measured by vibration‐controlled transient elastography (VCTE) in detection of any oesophageal varices in adults with chronic liver disease. We will regard a combination of tests as positive when at least one is positive.

To compare the diagnostic accuracy of individual tests (liver stiffness and spleen stiffness measured by VCTE) directly and versus the combination of both tests (considering positive when at least one is positive) in detecting any oesophageal varices.

To assess the diagnostic accuracy of liver stiffness and spleen stiffness, separately or in combination, as measured by other elastography techniques (2D‐shear wave elastography (2D‐SWE), point shear wave elastography (pSWE), magnetic resonance elastography (MRE)) in detection of any oesophageal varices in adults with chronic liver disease. We will regard a combination of tests as positive when at least one is positive.

To compare the diagnostic accuracy of liver stiffness and spleen stiffness measured by VCTE with other techniques (pSWE, 2D‐SWE, MRE) in detection of any oesophageal varices in adults with chronic liver disease.

• Biomarkers
• Elasticity imaging techniques
• Liver fibrosis
• Parasitic liver diseases
• Schistosoma mansoni
• Ultrasonography

• Elasticity imaging techniques
• Esophageal and gastric varices
• Liver cirrhosis
• Spleen

• elasticity imaging techniques
• esophageal and gastric varices
• gastrointestinal hemorrhage
• liver cirrhosis

• Cirrhosis
• Decompensation
• Elastography
• Spleen
• Varices

• Elastography
• Hepatic fibrosis
• Portal hypertension
• Schistosomiasis
• Ultrasonography

• Esophageal varices
• Liver elastography
• Liver stiffness
• Spleen elastography
• Spleen stiffness

To systematically review studies on the diagnostic accuracy of spleen stiffness measurement (SSM) for the detection of clinical significant portal hypertension (CSPH), severe portal hypertension (SPH), esophageal varices (EV), and high-risk esophageal varices (HREV) in patients with chronic liver diseases (CLD).

Through a systematic search, we identified 32 studies reporting the accuracy of SSM for the diagnosis of portal hypertension (PH) and/or EV in adults with CLD. A bivariate random-effects model was performed to estimate pooled sensitivity, specificity, likelihood ratio, positive predictive value (PPV), negative predictive value (NPV), and diagnostic odds ratios (DOR). The clinical utility of SSM was evaluated by Fagan plot.

A total of 32 studies assessing 3952 patients were included in this meta-analysis. The pooled sensitivities of SSM were 0.85 (95% confidence interval (CI), 0.69–0.93) for CSPH; 0.84 (95% CI, 0.75–0.90) for SPH; 0.90 (95% CI, 0.83–0.94) for any EV; and 0.87 (95% CI, 0.77–0.93) for HREV. The pooled specificities of SSM were 0.86 (95% CI, 0.74–0.93) for CSPH; 0.84 (95% CI, 0.72–0.91) for SPH; 0.73 (95% CI, 0.66–0.79) for EV; and 0.66 (95% CI, 0.53–0.77) for HREV. Summary PPV and NPV of SSM for detecting HREV were 0.54 (95% CI, 0.47–0.62) and 0.88 (95% CI, 0.81–0.95), respectively.

Our meta-analysis suggests that SSM could be used as a helpful surveillance tool in management of CLD patients and was quite useful for ruling out the presence of HREV thereby avoiding unnecessary endoscopy.

• SSM could be used to rule out the presence of HREV in patients with CLD thereby avoiding unnecessary endoscopy.

• SSM has significant diagnostic value for CSPH and SPH with high sensitivity and specificity in patients with CLD.

• SSM could be used as a helpful surveillance tool for clinicians managing CLD patients.

The online version of this article (10.1007/s00330-020-07223-8) contains supplementary material, which is available to authorized users.

• Diagnosis
• Elasticity imaging techniques
• Esophageal varices
• Portal hypertension
• Spleen

• Chronic hepatitis B
• Hepatocellular carcinoma
• Liver cirrhosis
• Multidetector computed tomography
• Splenomegaly

• Baveno criteria
• Liver cirrhosis
• Portal hypertension
• Varices

• Elasticity Imaging Techniques/methods
• Endoscopy/methods
• Endoscopy/standards
• Endoscopy, Digestive System/methods
• Endoscopy, Digestive System/standards
• Esophageal and Gastric Varices/diagnosis
• Esophageal and Gastric Varices/etiology
• Esophageal and Gastric Varices/therapy
• Hemorrhage/epidemiology
• Hemorrhage/prevention & control
• Humans
• Hypertension, Portal/complications
• Hypertension, Portal/physiopathology
• Incidence
• Liver Cirrhosis/complications
• Mass Screening/methods

Elastography-based liver stiffness measurement (LSM) is a non-invasive tool for estimating liver fibrosis but also provides an estimate for the severity of portal hypertension in patients with advanced chronic liver disease (ACLD). The presence of varices and especially of varices needing treatment (VNT) indicates distinct prognostic stages in patients with compensated ACLD (cACLD). The Baveno VI guidelines suggested a simple algorithm based on LSM < 20 kPa (by transient elastography, TE) and platelet count > 150 G/L for ruling-out VNT in patients with cACLD. These (and other) TE-based LSM cut-offs have been evaluated for VNT screening in different liver disease etiologies. Novel point shear-wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) methodologies for LSM have also been evaluated for their ability to screen for “any” varices and for VNT. Finally, the measurement of spleen stiffness (SSM) by elastography (mainly by pSWE and 2D-SWE) may represent another valuable screening tool for varices. Here, we summarize the current literature on elastography-based prediction of “any” varices and VNT. Finally, we have summarized the published LSM and SSM cut-offs in clinically useful scale cards.

• Elastography
• Liver stiffness
• Spleen stiffness
• Shear wave
• Magnetic resonance elastography
• Varices
• Portal hypertension
• Cirrhosis
• Advanced chronic liver disease

• Clinical Protocols/standards
• Echo-Planar Imaging/methods
• Echo-Planar Imaging/standards
• Elasticity Imaging Techniques/methods
• Elasticity Imaging Techniques/standards
• Esophageal and Gastric Varices/diagnosis
• Esophageal and Gastric Varices/etiology
• Humans
• Hypertension, Portal/diagnosis
• Hypertension, Portal/etiology
• Liver/diagnostic imaging
• Liver/pathology
• Liver Cirrhosis/complications
• Liver Cirrhosis/diagnostic imaging
• Liver Cirrhosis/pathology
• Mass Screening/methods
• Mass Screening/standards
• Practice Guidelines as Topic
• Prognosis

• cirrhosis
• elastography
• esophageal varices
• liver stiffness
• significant/high risk esophageal varices
• spleen stiffness

• Adult
• Aged
• Elasticity
• Esophageal and Gastric Varices/diagnosis
• Humans
• Liver/pathology
• Liver/physiopathology
• Middle Aged
• Platelet Count
• ROC Curve
• Sensitivity and Specificity
• Spleen/pathology
• Spleen/physiopathology
• Young Adult

A colorimetric probe for determination of As(III) ions in aqueous solutions on basis of localized surface plasmon resonance (LSPR) was synthesized. The dithiothreitol molecules with two end thiols covalently combined with Au Nanorods (AuNRs) with an aspect ratio of 2.9 by Au-S bond to form dithiothreitol coated Au Nanorods (DTT-AuNRs), acting as colorimetric probe for the determination of As(III) ions. With the adding of As(III) ions, the AuNRs will be aggregated and leading the longitudinal SPR absorption band of DTT-AuNRs decrease due to the As(III) ions can bind with three DTT molecules through an As-S linkage. The potential factors affect the response of DTT-AuNRs to As(III) ions including the concentration of DTT, pH values of DTT-AuNRs, reaction time and NaCl concentration were optimized. Under optimum assay conditions, the DTT-AuNRs colorimetric probe has high sensitivity towards As(III) ions with low detection limit of 38 nM by rules of 3σ/k and excellent linear range of 0.13–10.01 μM. The developed colorimetric probe shows high selectivity for As(III) ions sensing and has applied to determine of As(III) in environmental water samples with quantitative spike-recoveries range from 95.2% to 100.4% with low relative standard deviation of less than 4.4% (n = 3).

• arsenic ions
• colorimetric probe
• dithiothreitol
• gold nanorods

• Esophageal varices
• computed tomography
• elastography
• magnetic resonance imaging

Portal hypertension is a major pathophysiology in patients with cirrhosis. Portal pressure is the gold standard to evaluate the severity of portal hypertension, and radiological intervention is the only procedure for pressure measurement. Ultrasound (US) is a simple and noninvasive imaging modality available worldwide. B-mode imaging allows broad applications for patients to detect and characterize chronic liver diseases and focal hepatic lesions. The Doppler technique offers real-time observation of blood flow with qualitative and quantitative assessments, and the application of microbubble-based contrast agents has improved the detectability of peripheral blood flow. In addition, elastography for the liver and spleen covers a wider field beyond the original purpose of fibrosis assessment. These developments enhance the practical use of US in the evaluation of portal hemodynamic abnormalities. This article reviews the recent progress of US in the assessment of portal hypertension.

• Contrast media
• Hypertension, portal
• Liver
• Ultrasonography, Doppler

• Esophagogastric varices
• Liver stiffness
• Point shear wave elastography
• Portal hypertension
• Spleen stiffness

• Adult
• Aged
• Aged, 80 and over
• Elasticity Imaging Techniques/methods
• Esophageal and Gastric Varices/complications
• Esophageal and Gastric Varices/diagnostic imaging
• Esophageal and Gastric Varices/physiopathology
• Feasibility Studies
• Female
• Humans
• Hypertension, Portal/physiopathology
• Male
• Middle Aged
• Reproducibility of Results
• Spleen/diagnostic imaging
• Spleen/physiopathology

To assess the value of combined acoustic radiation force impulse (ARFI) imaging, serological indexes and contrast-enhanced ultrasound (CEUS) in distinguishing between benign and malignant liver lesions.

Patients with liver lesions treated at our hospital were included in this study. The lesions were divided into either a malignant tumor group or a benign tumor group according to pathological or radiological findings. ARFI quantitative detection, serological testing and CEUS quantitative detection were performed and compared. A comparative analysis of the measured indexes was performed between these groups. Receiver operating characteristic (ROC) curves were constructed to compare the diagnostic accuracy of ARFI imaging, serological indexes and CEUS, alone or in different combinations, in identifying benign and malignant liver lesions.

A total of 112 liver lesions in 43 patients were included, of which 78 were malignant and 34 were benign. Shear wave velocity (SWV) value, serum alpha-fetoprotein (AFP) content and enhancement rate were significantly higher in the malignant tumor group than in the benign tumor group (2.39 ± 1.20 m/s vs 1.50 ± 0.49 m/s, 18.02 ± 5.01 ng/mL vs 15.96 ± 4.33 ng/mL, 2.14 ± 0.21 dB/s vs 2.01 ± 0.31 dB/s; P < 0.05). The ROC curve analysis revealed that the areas under the curves (AUCs) of SWV value alone, AFP content alone, enhancement rate alone, SWV value + AFP content, SWV value + enhancement rate, AFP content + enhancement rate and SWV value + AFP content + enhancement rate were 85.1%, 72.1%, 74.5%, 88.3%, 90.4%, 82.0% and 92.3%, respectively. The AUC of SWV value + AFP content + enhancement rate was higher than those of SWV value + AFP content and SWV value + enhancement rate, and significantly higher than those of any single parameter or the combination of any two of parameters.

The combination of SWV, AFP and enhancement rate had better diagnostic performance in distinguishing between benign and malignant liver lesions than the use of any single parameter or the combination of any two of parameters. It is expected that this would provide a tool for the differential diagnosis of benign and malignant liver lesions.

• Combined diagnosis
• Liver lesions
• Benign
• Malignant
• Differentiation

• Biopsy, Needle
• Carcinoma, Hepatocellular/blood
• Carcinoma, Hepatocellular/diagnostic imaging
• Carcinoma, Hepatocellular/pathology
• Contrast Media/administration & dosage
• Diagnosis, Differential
• Elasticity Imaging Techniques/methods
• Female
• Humans
• Liver/diagnostic imaging
• Liver/pathology
• Liver Neoplasms/blood
• Liver Neoplasms/diagnostic imaging
• Liver Neoplasms/pathology
• Male
• ROC Curve
• Radiography
• Sensitivity and Specificity
• Ultrasonography/methods
• alpha-Fetoproteins/analysis

• Advanced chronic liver disease
• Cirrhosis
• Decompensation
• Non-invasive
• Varices

• Chronic Liver Diseases
• Fibrosis
• Guidelines
• Noninvasive Imaging

• Baveno VI criteria
• Hepatic venous pressure gradient
• Liver stiffness measurement
• Magnetic resonance elastography
• Transient elastography
• Variceal bleeding

The development of liver cirrhosis and portal hypertension (PH), one of its major complications, are structural and functional alterations of the liver, occurring in many patients with chronic liver diseases (CLD). Actually the progressive deposition of hepatic fibrosis has a key role in the prognosis of CLD patients. The subsequent development of PH leads to its major complications, such as ascites, hepatic encephalopathy, variceal bleeding and decompensation. Liver biopsy is still considered the reference standard for the assessment of hepatic fibrosis, whereas the measurement of hepatic vein pressure gradient is the standard to ascertain the presence of PH and upper endoscopy is the method of choice to detect the presence of oesophageal varices. However, several non-invasive tests, including elastographic techniques, are currently used to evaluate the severity of liver disease and predict its prognosis. More recently, the measurement of the spleen stiffness has become particularly attractive to assess, considering the relevant role accomplished by the spleen in splanchnic circulation in the course of liver cirrhosis and in the PH. Moreover, spleen stiffness as compared with liver stiffness better represents the dynamic changes occurring in the advanced stages of cirrhosis and shows higher diagnostic performance in detecting esophageal varices. The aim of this review is to provide an exhaustive overview of the actual role of spleen stiffness measurement as assessed by several elastographic techniques in evaluating both liver disease severity and the development of cirrhosis complications, such as PH and to highlight its potential and possible limitations.

• Cirrhosis
• Spleen stiffness
• Elastography
• Portal hypertension
• Transient elastography

• Animals
• Ascites/pathology
• Biopsy/adverse effects
• Chronic Disease
• Disease Progression
• Elasticity Imaging Techniques/methods
• Esophageal and Gastric Varices/complications
• Fibrosis/physiopathology
• Gastrointestinal Hemorrhage/pathology
• Humans
• Hypertension, Portal/physiopathology
• Liver/pathology
• Liver Cirrhosis/diagnosis
• Liver Diseases/diagnosis
• Liver Diseases/pathology
• Predictive Value of Tests
• Pressure
• Prognosis
• Reproducibility of Results
• Severity of Illness Index
• Spleen/pathology

Progressive fibrosis is encountered in almost all chronic liver diseases. Its clinical signs are diagnostic in advanced cirrhosis, but compensated liver cirrhosis is harder to diagnose. Liver biopsy is still considered the reference method for staging the severity of fibrosis, but due to its drawbacks (inter and intra-observer variability, sampling errors, unequal distribution of fibrosis in the liver, and risk of complications and even death), non-invasive methods were developed to assess fibrosis (serologic and elastographic). Elastographic methods can be ultrasound-based or magnetic resonance imaging-based. All ultrasound-based elastographic methods are valuable for the early diagnosis of cirrhosis, especially transient elastography (TE) and acoustic radiation force impulse (ARFI) elastography, which have similar sensitivities and specificities, although ARFI has better feasibility. TE is a promising method for predicting portal hypertension in cirrhotic patients, but it cannot replace upper digestive endoscopy. The diagnostic accuracy of using ARFI in the liver to predict portal hypertension in cirrhotic patients is debatable, with controversial results in published studies. The accuracy of ARFI elastography may be significantly increased if spleen stiffness is assessed, either alone or in combination with liver stiffness and other parameters. Two-dimensional shear-wave elastography, the ElastPQ technique and strain elastography all need to be evaluated as predictors of portal hypertension.

• Portal hypertension
• Transient elastography
• Acoustic radiation force impulse elastography
• Two-dimensional shear-wave elastography

• Early Diagnosis
• Elasticity Imaging Techniques/methods
• Humans
• Hypertension, Portal/etiology
• Hypertension, Portal/physiopathology
• Liver/diagnostic imaging
• Liver Cirrhosis/complications
• Liver Cirrhosis/diagnostic imaging
• Predictive Value of Tests
• Prognosis
• Reproducibility of Results
• Risk Assessment
• Risk Factors

Owing to the high prevalence of various chronic liver diseases, cirrhosis is one of the leading causes of morbidity and mortality worldwide. In recent years, the development of non-invasive tests of fibrosis allows accurate diagnosis of cirrhosis and reduces the need for liver biopsy. In this review, we discuss the application of these non-invasive tests beyond the diagnosis of cirrhosis. In particular, their role in the selection of patients for hepatocellular carcinoma surveillance and varices screening is highlighted.

• FibroScan
• FibroTest
• Hepatocellular carcinoma
• Transient elastography
• Varices

• AST to platelet ratio index
• Acoustic Radiation Force Impulse
• Liver fibrosis
• Transient elastography
• Viral hepatitis

Ultrasound elastography is perhaps the most important breakthrough in the evolution of ultrasonography in the last 15 years. Since transient elastography was introduced, many other methods have been developed and became more and more widely available. The value of ultrasound elastography in staging a chronic liver disease has been established by numerous studies. There have been many studies that have shown that using liver elastography it is possible to predict the presence of the complications of cirrhosis: portal hypertension, presence of esophageal varices (and even their risk of bleeding) and hepatocellular carcinoma. It has been shown that liver elastography can predict the progression of liver fibrosis and also the survival (hepatic events - free) of the patients with chronic liver diseases. These are the real quests of the clinicians, this is the ultimate scope of any medical investigation - to predict the outcome of a patient and to help making therapeutic decisions. I brought together only a small amount of the data that has already been written on this subject to support my affirmation that liver ultrasound elastography is more than a tool for staging the liver disease, but it is also comparable to a crystal ball which in the hands of a skilled clinician can reveal the future of the patient and can help to improve this future.

• Liver ultrasound elastography
• Transient elastography
• Fibrosis
• Hepatitis
• Survival
• Cirrhosis

• WFUMB
• elastography
• focal liver lesions
• guidelines
• liver
• liver diseases
• liver fibrosis
• liver stiffness
• shear wave elastography
• strain elastography
• transient elastography
• ultrasound

• Elastic Modulus
• Elasticity Imaging Techniques/standards
• Internationality
• Liver/diagnostic imaging
• Liver/physiopathology
• Liver Cirrhosis/diagnostic imaging
• Liver Cirrhosis/physiopathology
• Practice Guidelines as Topic
• Shear Strength
• Stress, Mechanical

• 16464 Cancer Research UK

• Adolescent
• Child
• Child, Preschool
• Elasticity Imaging Techniques
• Female
• Humans
• Hypertension, Portal/diagnostic imaging
• Hypertension, Portal/physiopathology
• Liver Transplantation
• Living Donors
• Male
• Postoperative Complications/diagnostic imaging
• Postoperative Complications/physiopathology
• Prospective Studies
• Sensitivity and Specificity
• Spleen/diagnostic imaging
• Spleen/pathology

Few noninvasive methods can accurately identify esophageal varices (EVs) in patients with compensated cirrhosis. We developed and validated a novel, acoustic radiation force impulse (ARFI) elastography-based prediction model for high-risk EVs (HEVs) in patients with compensated cirrhosis.

A total of 143 patients with compensated cirrhosis between February, 2010 and February, 2013 (training set) and 148 between June, 2010 and May, 2013 (validation set) who underwent ARFI elastography and endoscopy were prospectively recruited. Independent predictors of HEVs were used to construct a prediction model.

Based on multivariate analysis, we developed two new statistical models, a varices risk score and ARFI-spleen diameter-to-platelet ratio score (ASPS), the latter of which was calculated as ARFI velocity × spleen diameter/platelet count. The area under receiver operating characteristic curve (AUROC) of the varices risk score and ASPS to predict HEVs were 0.935 (95% confidence interval [CI] 0.882–0.970) and 0.946 (95% CI 0.895–0.977), respectively. When ASPS, a simpler model with a higher AUROC, was applied in the validation set, acceptable diagnostic accuracy for HEVs was observed (AUROC = 0.814 [95% CI 0.743–0.885]). To detect HEVs, a negative predictive value of 98.3% was achieved at ASPS <2.83, whereas a positive predictive value of 100% was achieved at ASPS >5.28.

ASPS, a novel noninvasive ARFI-based prediction model, can accurately identify HEVs in patients with compensated cirrhosis. ASPS <2.83 may safely rule out the presence of HEVs, whereas patients with ASPS >5.28 should be considered for endoscopic examinations or appropriate prophylactic treatment.

• Acoustics
• Elasticity Imaging Techniques
• Esophageal and Gastric Varices/etiology
• Female
• Humans
• Liver Cirrhosis/complications
• Male
• Middle Aged

Liver cirrhosis (LC), the end stage of many forms of chronic hepatitis of different etiologies is a diffuse process characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules surrounded by annular fibrosis. This chronic progressive clinical condition, leads to liver cell failure and portal hypertension, which can favour the onset of hepatocellular carcinoma. Defining the phase of the natural history is crucial for therapeutic choice and prognosis. Liver biopsy is currently considered the best available standard of reference but it has some limits, so alternative tools have been developed to substitute liver biopsy when assessing liver fibrosis. Serum markers offer a cost-effective alternative to liver biopsy being less invasive and theoretically without complications. They can be classified into direct and indirect markers which may be used alone or in combination to produce composite scores. Diagnostic imaging includes a number of instruments and techniques to estimate liver fibrosis and cirrhosis like ultrasound (US), US Doppler, contrast enhanced US and Elastography. US could be used for the diagnosis of advanced LC while is not able to evaluate progression of fibrosis, in this case Elastography is more reliable. This review aims to revise the most recent data from the literature about non invasive methods useful in defining liver fibrosis.

• Liver fibrosis
• Liver biopsy
• Ultrasound
• Elastography
• Serum markers

• Biomarkers/blood
• Biopsy
• Contrast Media
• Diagnostic Imaging/methods
• Elasticity Imaging Techniques
• Humans
• Liver/diagnostic imaging
• Liver/metabolism
• Liver/pathology
• Liver Cirrhosis/blood
• Liver Cirrhosis/diagnosis
• Liver Cirrhosis/diagnostic imaging
• Liver Cirrhosis/pathology
• Predictive Value of Tests
• Prognosis
• Reproducibility of Results
• Severity of Illness Index
• Ultrasonography, Doppler

• acoustic radiation force impulse
• hepatectomy
• hepatic fibrosis
• liver tumor
• morbidity
• ultrasonography

Progressive hepatic fibrosis can lead to cirrhosis, so its early detection is fundamental. Staging fibrosis is also critical for prognosis and management. The gold standard for these aims is liver biopsy, but it has several drawbacks, as it is invasive, expensive, has poor acceptance, is prone to inter observer variability and sampling errors, has poor repeatability, and has a risk of complications and mortality. Therefore, non-invasive imaging tests have been developed. This review mainly focuses on the role of transient elastography, acoustic radiation force impulse imaging, and magnetic resonance-based methods for the noninvasive diagnosis of cirrhosis.

• Liver
• Cirrhosis
• Elastography
• Acoustic radiation force impulse imaging
• Magnetic resonance elastography

• Acoustics
• Biopsy
• Diagnostic Imaging/methods
• Disease Progression
• Early Diagnosis
• Elasticity Imaging Techniques
• Humans
• Liver/diagnostic imaging
• Liver/pathology
• Liver Cirrhosis/diagnosis
• Magnetic Resonance Imaging
• Predictive Value of Tests
• Prognosis
• Severity of Illness Index

• Accuracy
• Cirrhosis
• Elastography
• Portal Hypertension

With advances in the management and treatment of advanced liver disease, including the use of antiviral therapy, a simple, one stage description for advanced fibrotic liver disease has become inadequate. Although refining the diagnosis of cirrhosis to reflect disease heterogeneity is essential, current diagnostic tests have not kept pace with the progression of this new paradigm. Liver biopsy and hepatic venous pressure gradient measurement are the gold standards for the estimation of hepatic fibrosis and portal hypertension (PHT), respectively, and they have diagnostic and prognostic value. However, they are invasive and, as such, cannot be used repeatedly in clinical practice. The ideal noninvasive test should be safe, easy to perform, inexpensive, reproducible as well as to give numerical and accurate results in real time. It should be predictive of long term outcomes related with fibrosis and PHT to allow prognostic stratification. Recently, many types of noninvasive alternative tests have been developed and are under investigation. In particular, imaging and ultrasound based tests, such as transient elastography, have shown promising results. Although most of these noninvasive tests effectively identify severe fibrosis and PHT, the methods available for diagnosing moderate disease status are still insufficient, and further investigation is essential to predict outcomes and individualize therapy in this field.

• Hepatic fibrosis
• Portal hypertension
• Liver biopsy
• Hepatic venous pressure gradient
• Non-invasive test
• Transient elastography

• Biopsy
• Diagnostic Imaging
• Elasticity Imaging Techniques
• Fibrosis
• Humans
• Hypertension, Portal/diagnosis
• Hypertension, Portal/diagnostic imaging
• Hypertension, Portal/pathology
• Liver/pathology
• Liver Cirrhosis/diagnosis
• Liver Cirrhosis/diagnostic imaging
• Liver Cirrhosis/pathology
• Magnetic Resonance Imaging
• Prognosis
• Tomography, X-Ray Computed
• Ultrasonography, Doppler