Évaluation non invasive de la fibrose hépatique

The assessment of liver fibrosis is an important step in the follow up of chronic liver diseases. The severity of fibrosis is a strong argument for initiating a strategy for the screening of complications of cirrhosis and has a useful prognostic value. It can also help to identify which patients should sooner receive antiviral therapy, although this indication tends to be contested in chronic viral hepatitis. Liver biopsy has been the gold standard for estimating the extent of fibrosis and inflammation, although it has some limitations. Non invasive methods were developed, including blood tests and liver stiffness measurement. These methods have been shown to perform well in ruling in cirrhosis, with a less ability to discriminate between intermediate stages. Several tests combinations improve the performances of individual tests, hence avoiding liver biopsy in many cases. In france, health authorities validated noninvasive methods in chronic hepatitis C solely, but these tests are regularly integrated by international associations in their clinical guidelines, extending their use in many other etiologies. Nowadays, since clinical recommendations are moving in this field, non invasive methods have to respond to other attempts, particularly by predicting clinical outcomes of fibrosis and treatment response in viral hepatitis.