Non-invasive assessment of liver fibrosis and prognosis: an update on serum and elastography markers

Expert Rev Gastroenterol Hepatol. 2019 Apr;13(4):361-374. doi: 10.1080/17474124.2019.1579641. Epub 2019 Feb 20.


Non-invasive assessment of fibrosis is increasingly utilized in clinical practice to diagnose hepatic fibrosis. Non-invasive assessment of liver fibrosis relies on biologic and/or physical properties to assess tissue fibrosis. Serum markers estimate fibrosis by incorporating markers reflecting hepatic function (indirect markers) and/or markers measuring extracellular matrix degradation/fibrogenesis (direct markers). Radiology based techniques relay the mechanical properties and stiffness of a tissue, with increased stiffness associated with more advanced fibrosis. Areas covered: In this comprehensive review, the recent literature discussing serum markers and elastography-based techniques will be covered. These modalities are also explored in the setting of various liver diseases. Expert opinion: The etiology of liver disease and clinical context should be taken into consideration when non-invasive markers are incorporated in clinical practice. Non-invasive assessment of fibrosis has been most extensively utilized in hepatitis C, followed by hepatitis B and nonalcoholic fatty liver disease, but its role remains less developed in other etiologies of liver disease such as alcohol-associated liver disease and autoimmune liver disease. The role of non-invasive markers in predicting progression or regression of fibrosis, development of liver-related events and survival needs to be further explored.

Keywords: Elastography; hepatitis B; hepatitis C; liver fibrosis; liver stiffness; magnetic resonance elastography; nonalcoholic fatty liver disease; shear wave elastography; vibration-controlled transient elastography.

Publication types

  • Review

MeSH terms

  • Animals
  • Biomarkers / blood
  • Elasticity Imaging Techniques*
  • Humans
  • Liver / diagnostic imaging*
  • Liver / metabolism*
  • Liver Cirrhosis / blood*
  • Liver Cirrhosis / diagnostic imaging*
  • Liver Cirrhosis / epidemiology
  • Liver Cirrhosis / therapy
  • Liver Function Tests*
  • Predictive Value of Tests
  • Prognosis
  • Reproducibility of Results
  • Risk Factors
  • Severity of Illness Index


  • Biomarkers