Li Chengxi, Li Rentao, Zhang Wei
Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139, USA.
Department of Hepatobiliary Surgery, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China.
Cancer Biol Med. 2018 May;15(2):124-136. doi: 10.20892/j.issn.2095-3941.2018.0018.
Liver fibrosis is an important pathological precondition for hepatocellular carcinoma. The degree of hepatic fibrosis is positively correlated with liver cancer. Liver fibrosis is a series of pathological and physiological process related to liver cell necrosis and degeneration after chronic liver injury, which finally leads to extracellular matrix and collagen deposition. The early detection and precise staging of fibrosis and cirrhosis are very important for early diagnosis and timely initiation of appropriate therapeutic regimens. The risk of severe liver fibrosis finally progressing to liver carcinoma is >50%. It is known that biopsy is the gold standard for the diagnosis and staging of liver fibrosis. However, this method has some limitations, such as the potential for pain, sampling variability, and low patient acceptance. Furthermore, the necessity of obtaining a tissue diagnosis of liver fibrosis still remains controversial. An increasing number of reliable non-invasive approaches are now available that are widely applied in clinical practice, mostly in cases of viral hepatitis, resulting in a significantly decreased need for liver biopsy. In fact, the non-invasive detection and evaluation of liver cirrhosis now has good accuracy due to current serum markers, ultrasound imaging, and magnetic resonance imaging quantification techniques. A prominent advantage of the non-invasive detection and assessment of liver fibrosis is that liver fibrosis can be monitored repeatedly and easily in the same patient. Serum biomarkers have the advantages of high applicability (>95%) and good reproducibility. However, their results can be influenced by different patient conditions because none of these markers are liver-specific. The most promising techniques appear to be transient elastography and magnetic resonance elastography because they provide reliable results for the detection of fibrosis in the advanced stages, and future developments promise to increase the reliability and accuracy of the staging of hepatic fibrosis. This article aims to describe the recent progress in the development of non-invasive assessment methods for the staging of liver fibrosis, with a special emphasize on computer-aided quantitative and deep learning methods.
肝纤维化是肝细胞癌重要的病理前提。肝纤维化程度与肝癌呈正相关。肝纤维化是慢性肝损伤后与肝细胞坏死和变性相关的一系列病理生理过程，最终导致细胞外基质和胶原沉积。纤维化和肝硬化的早期检测及精确分期对于早期诊断和及时启动恰当治疗方案非常重要。严重肝纤维化最终进展为肝癌的风险超过50%。已知活检是肝纤维化诊断和分期的金标准。然而，该方法存在一些局限性，如可能引起疼痛、取样变异性以及患者接受度低。此外，获取肝纤维化组织诊断的必要性仍存在争议。现在有越来越多可靠的非侵入性方法，广泛应用于临床实践，主要用于病毒性肝炎病例，从而显著减少了肝活检的需求。事实上，由于目前的血清标志物、超声成像和磁共振成像定量技术，现在对肝硬化的非侵入性检测和评估具有良好的准确性。非侵入性检测和评估肝纤维化的一个突出优点是可以在同一患者中轻松反复监测肝纤维化。血清生物标志物具有高适用性（>95%）和良好的可重复性的优点。然而，它们的结果可能受不同患者情况的影响，因为这些标志物均非肝脏特异性。最有前景的技术似乎是瞬时弹性成像和磁共振弹性成像，因为它们为晚期纤维化检测提供可靠结果，并且未来的发展有望提高肝纤维化分期的可靠性和准确性。本文旨在描述肝纤维化分期非侵入性评估方法发展的最新进展，特别强调计算机辅助定量和深度学习方法。
