Noninvasive diagnosis of periportal fibrosis in schistosomiasis mansoni: A comprehensive review

Table 6 Advantages and limitations of noninvasive periportal fibrosis techniques frequently used in clinical practice with regard to Schistosomiasis mansoni infected patients

Techniques	Advantages	Limitations
Blood Platelet Count	Low cost, routine laboratory test, easy access	Difficult to diagnose patients with initial PPF
APRI	Low cost, based on routine laboratory tests, easy access	More frequently used to diagnose patients with portal hyperpertension and esophageal varices, less sensitive for PPF
Coutinho index	Low cost, based on routine laboratory tests (alkaline phosphatase and platelet count), easy access, lets advanced PPF be identified	These tests need to be validated in other centers
Ultrasound	Low cost, safe and based on the Niamey-WHO protocol	Operator dependent
MRI/CT	MRI is more sensitive than ultrasound at diagnosing PPF	Expensive, use of radiation, not available in endemic areas, no relation with the Niamey-WHO protocol
Liver elastography	Good accuracy, distinguishes mild from significant PPF	Expensive, not available in endemic areas
Spleen elastography	Related to portal hypertension	Expensive, not available in endemic areas, needs further studies
Wedge liver biopsy	Gold standard used to diagnose Symmers fibrosis	Only for surgical patients
Percutaneous liver biopsy	Can be used in differential diagnosis between schistosomiasis and other liver diseases	Insufficiently sensitive and so may fail to diagnose PPF

CT: Computer tomography; PPF: Periportal fibrosis; MRI: Magnetic resonance imaging; WHO: World Health Organization.