KASL clinical practice guidelines: management of hepatitis C

2014 Clinical and Molecular Hepatology 20, 2 (89-136)

Noninvasive tests for evaluation of liver fibrosis
[...] Liver stiffness measurement using transient elastography can be used to assess hepatic fibrosis, although it is not approved by the Food and Drug Administration as of 2013. Transient elastography cannot totally replace liver biopsy, because it often cannot produce reliable measurements in obese patients, and tends to give falsely high results in cases of acute hepatitis with severe inflammation and necrosis with mild fibrosis. In case of chronic hepatitis C, cutoff values determining significant fibrosis (?F2) vary from study-to-study, ranging from 7.1 to 8.8 kPa, with an AUROC of 0.79-0.83.198 The AUROC of transient elastography for diagnosis of liver cirrhosis ranged from 0.95-0.97, with cutoff value of 12.5-14.6 kPa (77-78% positive predictive value, 95-97% negative predictive value).
Other newly developed noninvasive tests include acoustic radiation force impulse (ARFI) imaging, real time elastography, magnetic resonance (MR) elastography, diffusion-weighted MR image, and MR spectroscopy. However, validations of their effectiveness are still needed.
Liver biopsy (B2) and/or noninvasive test for assessment of hepatic fibrosis (C2) can be done to make treatment decision and to predict prognosis.

Pubmed : 25032178