Non-invasive diagnosis of advanced fibrosis and cirrhosis

Table 1 Summary performance characteristics for selected serum- and radiology-based noninvasive markers for the diagnosis of cirrhosis

Test	Etiology (Ref.)	Cutoff	Sens(%)	Spec(%)	AUC	Advantage	Disadvantage
Serum markers
APRI	HCV[59]	> 2.0	48	94	0.84	Easy to calculate	Lower diagnostic value in comparative studies
FIB-4	HCV[71]	< 1.45	74	80	0.85	Easy to calculate	Not well validated in all etiologies of CLD (e.g., Autoimmune liver disease)
		> 3.25	38	98
Fibrotest	HCV[59]	> 0.66	77	82	0.89	Validated in a number of etiologies; may correlate with fibrosis progression	Patented formula ($)
	HBV[64]	> 0.68	80	84	0.87
ELF	Mixed[92]	> 0.025	91	69	0.89	Validated in a number of etiologies, may have prognostic value	Requires levels of HA, TIMP1 and PIIINP
Radiologic markers
TE	Mixed[38]	> 15 (9-26)	83	89		Easy to use, validated in a number of etiologies, predicts complications of cirrhosis	Requires expensive equipment, less reliable in obese patients and acute hepatitis
ARFI	Mixed[48]	> 1.87	84	92	0.91	Easy to use, validated in a number of etiologies, allows measurement away from masses/lesions	Requires expensive equipment, less reliable in obese patients, smaller region of interest than standard TE
MRE	Mixed[57]	> 4.13	100	96	0.998	Highly accurate, fibrosis estimation over a much larger area than TE or ARFI	Requires expensive equipment and radiology expertise, results may change with patient positioning

APRI: AST to platelet ratio index; FIB-4: Fibrosis-4; ELF: Enhanced liver fibrosis; TE: Transient elastography; ARFI: Acoustic radiation force impulse; MRE: Magnetic resonance elastography; HBV: Hepatitis B virus; HCV: Hepatitis C virus; CLD: Chronic liver disease.