Bota S, Peck-Radosavljevic M
Department of Gastroenterology and Hepatology AKH and Medical University of Vienna Vienna, Austria -
Minerva Gastroenterol Dietol. 2014 Mar;60(1):39-54.
Liver fibrosis evaluation is essential in patients with chronic viral liver disease with major impact on treatment decisions. Liver biopsy is still considered the "gold-standard", but it is an invasive method, non-totally risk free, not very well accepted by patients, and unsuitable for regular follow-up examinations. In the last 10-15 years, several non-invasive methods for liver fibrosis assessment were developed: serological tests (simple or complex), ultrasound based elastographic methods (which can be classified in shear wave elastography methods and strain elastography methods) and magnetic resonance elastography. Today in clinical practice, ultrasound based elastographic methods are mostly used. From this category of methods, the oldest and more used is transient elastography, which was included also in several guidelines for assessing liver fibrosis in chronic hepatitis B and C patients. Each method has his advantages and weakness and today there is no consensus regarding which method should be considered the best "surrogate" for liver biopsy. Here we will try to give a comprehensive overview about the different techniques and depict the advantages and disadvantages of each of these methods.
肝纤维化评估对于慢性病毒性肝病患者至关重要，对治疗决策有重大影响。肝活检仍被视为“金标准”，但它是一种侵入性方法，并非完全无风险，患者接受度不高，也不适用于定期随访检查。在过去10至15年中，开发了几种用于肝纤维化评估的非侵入性方法：血清学检测（简单或复杂）、基于超声的弹性成像方法（可分为剪切波弹性成像方法和应变弹性成像方法）以及磁共振弹性成像。如今在临床实践中，大多使用基于超声的弹性成像方法。在这类方法中，最古老且使用最多的是瞬时弹性成像，它也被纳入了多项评估慢性乙型和丙型肝炎患者肝纤维化的指南中。每种方法都有其优缺点，目前对于哪种方法应被视为肝活检的最佳“替代”方法尚无共识。在此，我们将尝试对不同技术进行全面概述，并描述每种方法的优缺点。
