Published online Sep 14, 2014. doi: 10.3748/wjg.v20.i34.12031
Revised: February 9, 2014
Accepted: April 15, 2014
Published online: September 14, 2014
Infection with hepatitis B virus is an important health problem worldwide: it affects more than 350 million people and is a leading cause of liver-related morbidity, accounting for 1 million deaths annually. Hepatic fibrosis is a consequence of the accumulation of extracellular matrix components in the liver. An accurate diagnosis of liver fibrosis is essential for the management of chronic liver disease. Liver biopsy has been considered the gold standard for diagnosing disease, grading necroinflammatory activity, and staging fibrosis. However, liver biopsy is unsuitable for repeated evaluations because it is invasive and can cause major complications, including death. Several noninvasive evaluations have been introduced for the assessment of liver fibrosis: serum biomarkers, combined indices or scores, and imaging techniques including transient elastography, acoustic radiation force impulse, real-time tissue elastography, and magnetic resonance elastography. Here, we review the recent progress of noninvasive assessment of liver fibrosis in patients with chronic hepatitis B. Most noninvasive evaluations for liver fibrosis have been validated first in patients with chronic hepatitis C, and later in those with chronic hepatitis B. The establishment of a noninvasive assessment of liver fibrosis is urgently needed to aid in the management of this leading cause of chronic liver disease.
Core tip: The usefulness of noninvasive evaluations for predicting liver fibrosis remains to be fully evaluated in chronic hepatitis B. Few indices/scores based on combinations of serum biomarkers were originally proposed for use in patients with chronic hepatitis B. Transient elastography is less accurate for chronic hepatitis B than for chronic hepatitis C. Limited data are available regarding the usefulness of acoustic radiation force impulse, real-time tissue elastography, and magnetic resonance elastography in chronic hepatitis B. However, these methods are suitable for repeated evaluations and can be useful for assessing the clinical stage of disease, predicting complications of cirrhosis, and monitoring the response to treatment.