Cirrhosis diagnostic study of choice: Difference between revisions

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== Overview ==
== Overview ==
* The gold standard for diagnosing cirrhosis is:
In developing countries, [[liver biopsy]] is the gold standard test for the diagnosis of cirrhosis. The presence of bridging fibrous septa, [[Parenchyma|parenchymal]] [[Nodule (medicine)|nodules]] bearing a mixture of replicating and sensecent [[Hepatocyte|hepatocytes]] and involvement of most or all of the [[liver]] are confirmatory of [[cirrhosis]]. [[Liver biopsy]] helps in confirmation of the [[diagnosis]], determination of [[prognosis]], underlying [[etiology]], management of [[Transplant rejection|rejection]] subsequent to [[liver transplantation]] and evaluation of abnormal [[Liver|hepatic]] investigations. Sample of the [[liver]] may be obtained by [[Percutaneous]], transjugular and [[Laparoscopic surgery|laparoscopic]] radiographically- guided fine-needle approach. However, [[percutaneous]] [[liver biopsy]] is considered as the cornerstone of diagnosis. In developed countries, Fibroscan (transient [[elastography]]) is replacing [[liver biopsy]] as the gold standard diagnostic modality.
**Examination of an explanted liver, either at autopsy or following liver transplantation, because the architecture of the entire liver can be appreciated.
* The page name should be '''"[Disease name] diagnostic study of choice"''', with only the first letter of the title capitalized. Note that the page is called "Diagnostic study of choice."
* '''Goal:'''
**To describe the most efficient/sensitive/specific test that is utilized for diagnosis of [disease name].  
**To describe the gold standard test for the diagnosis of [disease name].
**To describe the diagnostic criteria, which may be based on clinical findings, physical exam signs, pathological findings, lab findings, findings on imaging, or even findings that exclude other diseases.
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== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==


===== Template statements =====
=== Gold standard/Study of choice in developing countries: ===
* Cirrhosis is primarily a [[Histology|histological]] diagnosis. [[Liver biopsy]] is the gold standard test for the diagnosis of cirrhosis.
* The following result of [[liver biopsy]] is confirmatory of cirrhosis:
** Presence of bridging fibrous [[Septum (disambiguation)|septa]]
** Parenchymal [[Nodule (medicine)|nodules]] bearing a mixture of replicating and sensecent [[Hepatocyte|hepatocytes]]
** Involvement of most or all of the [[liver]]
* [[Liver biopsy]] should be performed in order to:
** Confirm the [[diagnosis]]
** Determine prognosis
** Diagnose the underlying [[etiology]] of cirrhosis
*** [[Alcoholic liver disease]] : [[Liver biopsy]] may show [[hepatocyte]] necrosis, presence of [[Mallory body|mallory bodies]], neutrophilic infiltration and perivenular inflammation
*** [[Primary biliary cirrhosis|Primary biliary cirrhosis]] : [[Gold standard (test)|Gold standard diagnostic modality]] is the detection of [[antimitochondrial antibodies]] along with [[liver biopsy]] as confirmation if florid [[bile duct]] lesions
** Manage and evaluate [[Transplant rejection|rejection]] subsequent to [[liver transplantation]]
** Evaluate abnormal [[Liver|hepatic]] investigations
** Rule out [[Liver|hepatic]] [[Neoplasm|neoplasms]]
** Diagnose [[Cholestasis|cholestatic]] [[liver]] disease
** Evaluate infiltrative or [[Granuloma|granulomatous]] disease
** Evaluate unexplained [[jaundice]] 
** Evaluate [[Adverse drug reaction|drug reactions]]
** Monitor progression of diseases such as [[primary biliary cirrhosis]], [[Hepatitis C|chronic hepatitis C]]<sup> </sup>or [[alcoholic liver disease]]
* Cirrhosis is mainly diagnosed based on clinical presentation, [[Medical laboratory|laboratory]], and [[Radiologic sign|radiologic]] data.


=== Gold standard/Study of choice: ===
==== Features of liver biopsy<ref name="pmid9683971">{{cite journal |vauthors=Williams EJ, Iredale JP |title=Liver cirrhosis |journal=Postgrad Med J |volume=74 |issue=870 |pages=193–202 |year=1998 |pmid=9683971 |pmc=2360862 |doi= |url=}}</ref><ref name="pmid12865280">{{cite journal |vauthors=Blomley MJ, Lim AK, Harvey CJ, Patel N, Eckersley RJ, Basilico R, Heckemann R, Urbank A, Cosgrove DO, Taylor-Robinson SD |title=Liver microbubble transit time compared with histology and Child-Pugh score in diffuse liver disease: a cross sectional study |journal=Gut |volume=52 |issue=8 |pages=1188–93 |year=2003 |pmid=12865280 |pmc=1773750 |doi= |url=}}</ref><ref name="pmid11211142">{{cite journal |vauthors=Kim CK, Lim JH, Lee WJ |title=Detection of hepatocellular carcinomas and dysplastic nodules in cirrhotic liver: accuracy of ultrasonography in transplant patients |journal=J Ultrasound Med |volume=20 |issue=2 |pages=99–104 |year=2001 |pmid=11211142 |doi= |url=}}</ref><ref name="pmid443970">{{cite journal |vauthors=Abdi W, Millan JC, Mezey E |title=Sampling variability on percutaneous liver biopsy |journal=Arch. Intern. Med. |volume=139 |issue=6 |pages=667–9 |year=1979 |pmid=443970 |doi= |url=}}</ref><ref name="pmid14647056">{{cite journal |vauthors=Bedossa P, Dargère D, Paradis V |title=Sampling variability of liver fibrosis in chronic hepatitis C |journal=Hepatology |volume=38 |issue=6 |pages=1449–57 |year=2003 |pmid=14647056 |doi=10.1016/j.hep.2003.09.022 |url=}}</ref><ref name="pmid12385448">{{cite journal |vauthors=Regev A, Berho M, Jeffers LJ, Milikowski C, Molina EG, Pyrsopoulos NT, Feng ZZ, Reddy KR, Schiff ER |title=Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection |journal=Am. J. Gastroenterol. |volume=97 |issue=10 |pages=2614–8 |year=2002 |pmid=12385448 |doi=10.1111/j.1572-0241.2002.06038.x |url=}}</ref><ref name="pmid11172192">{{cite journal |vauthors=Bravo AA, Sheth SG, Chopra S |title=Liver biopsy |journal=N. Engl. J. Med. |volume=344 |issue=7 |pages=495–500 |year=2001 |pmid=11172192 |doi=10.1056/NEJM200102153440706 |url=}}</ref><ref name="pmid19243014">{{cite journal |vauthors=Rockey DC, Caldwell SH, Goodman ZD, Nelson RC, Smith AD |title=Liver biopsy |journal=Hepatology |volume=49 |issue=3 |pages=1017–44 |year=2009 |pmid=19243014 |doi=10.1002/hep.22742 |url=}}</ref> ====
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* Sample of the [[liver]] is obtained by:<ref name="pmid16636018">{{cite journal |vauthors=Cholongitas E, Quaglia A, Samonakis D, Senzolo M, Triantos C, Patch D, Leandro G, Dhillon AP, Burroughs AK |title=Transjugular liver biopsy: how good is it for accurate histological interpretation? |journal=Gut |volume=55 |issue=12 |pages=1789–94 |year=2006 |pmid=16636018 |pmc=1856467 |doi=10.1136/gut.2005.090415 |url=}}</ref>
* The following result of [gold standard test] is confirmatory of [disease name]:
**[[Percutaneous]]
** Result 1
**Transjugular 
** Result 2
**[[Laparoscopic surgery|Laparoscopic]] radiographically- guided fine-needle approach
* The [name of investigation] should be performed when:
* Percutaneous [[biopsy]] of focal lesions may be performed in combination with either [[ultrasound]] or [[CT|CT imaging]].<ref name="pmid15278290">{{cite journal |vauthors=Schirmacher P, Fleig WE, Tannapfel A, Langner C, Dries V, Terracciano L, Denk H, Dienes HP |title=[Bioptic diagnosis of chronic hepatitis. Results of an evidence-based consensus conference of the German Society of Pathology, of the German Society for Digestive and Metabolic Diseases and of Compensated Hepatitis (HepNet)] |language=German |journal=Pathologe |volume=25 |issue=5 |pages=337–48 |year=2004 |pmid=15278290 |doi=10.1007/s00292-004-0692-7 |url=}}</ref>
** The patient presented with symptoms/signs 1. 2, 3.
* Percutaneous [[liver biopsy]] is the cornerstone of diagnosis. It is quick and simple to perform [[liver biopsy]] in a patient with normal [[Platelet|platelet count]] and [[Prothrombin time|INR]].<ref name="pmid22833761">{{cite journal |vauthors=Tannapfel A, Dienes HP, Lohse AW |title=The indications for liver biopsy |journal=Dtsch Arztebl Int |volume=109 |issue=27-28 |pages=477–83 |year=2012 |pmid=22833761 |pmc=3402072 |doi=10.3238/arztebl.2012.0477 |url=}}</ref>
** A positive [test] is detected in the patient.
* Histologically, cirrhosis may be classified as micronodular, macronodular, or mixed, but this classification is nonspecific to the [[etiology]].
* [Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* Histology of the [[liver]] may change as the disease progresses, and [[Serology|serological]] markers are much more specific.
* The diagnostic study of choice for [disease name] is [name of investigation].
* There is a small but significant risk of [[liver biopsy]], and cirrhosis itself predisposes for complications due to [[liver biopsy]].<ref>{{cite journal |last=Grant |first=A|year=1999 | title=Guidelines on the use of liver biopsy in clinical practice |journal=Gut |volume=45 |issue=Suppl 4 |pages=1-11 |id=PMID 10485854 |url=http://gut.bmj.com/cgi/content/full/45/suppl_4/IV1|quote=The main cause of mortality after percutaneous liver biopsy is intraperitoneal haemorrhage as shown in a retrospective Italian study of 68,000 percutaneous liver biopsies in which all six patients who died did so from intraperitoneal haemorrhage. Three of these patients had had a laparotomy, and all had either cirrhosis or malignant disease, both of which are risk factors for bleeding. }}</ref>
* There is no single diagnostic study of choice for the diagnosis of [disease name].  
*Risks of [[liver biopsy]] include:
* There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
**[[Bleeding|Hemorrhage]]
* [Disease name] is mainly diagnosed based on clinical presentation.
**[[Bile duct|Biliary]] [[peritonitis]]
* Investigations:
**[[Hematoma]]
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
**[[Perforation]] of other [[Viscus|viscera]]
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
**[[Mortality rate|Mortality rates]] of between 0.01% and 0.1%
** Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.


==== The comparison table for diagnostic studies of choice for [disease name] ====
* Patients with moderate [[coagulopathy]]: 
{|
**Plugged [[liver biopsy]] : injection of gelatin sponges or metal coils down the tract after [[biopsy]]
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
**[[Laparoscopic surgery|Laparoscopic]] [[liver biopsy]] performed on a sedated patient with moderate [[coagulopathy]]
! style="background: #FFFFFF; color: #FFFFFF; text-align: center;" |
***Advantage: allows direct visualisation of the [[liver]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |✔
|}
<small> ✔= The best test based on the feature </small>
 
===== Diagnostic results =====
The following result of [investigation name] is confirmatory of [disease name]:
* Result 1
* Result 2
 
===== Sequence of Diagnostic Studies =====
The [name of investigation] should be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
 
==References==
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* For information on how to add references into your page, click [[Adding References to Articles|here]].


*Patients with severe [[Coagulation|clotting]] disorders:
**Transjugular [[liver biopsy]]:
***Risk of [[Peritoneum|intraperitoneal]] [[Bleeding|bleed]] is less
*** Disadvantages:
**** [[Biopsy|Biopsies]] are small: multiple [[Biopsy|biopsies]] required 
**** Taken 'blindly'
=== Gold standard/Study of choice in developed countries: ===
*Fibroscan or transient elastography has now replaced liver biopsy as the gold standard diagnostic modality in developed countries.
*Transient elastography and the Acoustic Radiation Force Impulse (ARFI) technique are well-established methods for the staging of [[fibrosis]] in cirrhosis: <ref name="pmid20581229">{{cite journal |vauthors=Castera L, Pinzani M |title=Biopsy and non-invasive methods for the diagnosis of liver fibrosis: does it take two to tango? |journal=Gut |volume=59 |issue=7 |pages=861–6 |year=2010 |pmid=20581229 |doi=10.1136/gut.2010.214650 |url=}}</ref><ref name="pmid22239521">{{cite journal |vauthors=Friedrich-Rust M, Nierhoff J, Lupsor M, Sporea I, Fierbinteanu-Braticevici C, Strobel D, Takahashi H, Yoneda M, Suda T, Zeuzem S, Herrmann E |title=Performance of Acoustic Radiation Force Impulse imaging for the staging of liver fibrosis: a pooled meta-analysis |journal=J. Viral Hepat. |volume=19 |issue=2 |pages=e212–9 |year=2012 |pmid=22239521 |doi=10.1111/j.1365-2893.2011.01537.x |url=}}</ref><ref name="pmid18395077">{{cite journal |vauthors=Friedrich-Rust M, Ong MF, Martens S, Sarrazin C, Bojunga J, Zeuzem S, Herrmann E |title=Performance of transient elastography for the staging of liver fibrosis: a meta-analysis |journal=Gastroenterology |volume=134 |issue=4 |pages=960–74 |year=2008 |pmid=18395077 |doi=10.1053/j.gastro.2008.01.034 |url=}}</ref><ref name="pmid15690481">{{cite journal |vauthors=Ziol M, Handra-Luca A, Kettaneh A, Christidis C, Mal F, Kazemi F, de Lédinghen V, Marcellin P, Dhumeaux D, Trinchet JC, Beaugrand M |title=Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C |journal=Hepatology |volume=41 |issue=1 |pages=48–54 |year=2005 |pmid=15690481 |doi=10.1002/hep.20506 |url=}}</ref><ref name="pmid14698338">{{cite journal |vauthors=Sandrin L, Fourquet B, Hasquenoph JM, Yon S, Fournier C, Mal F, Christidis C, Ziol M, Poulet B, Kazemi F, Beaugrand M, Palau R |title=Transient elastography: a new noninvasive method for assessment of hepatic fibrosis |journal=Ultrasound Med Biol |volume=29 |issue=12 |pages=1705–13 |year=2003 |pmid=14698338 |doi= |url=}}</ref><ref name="pmid23558397">{{cite journal |vauthors=Bamber J, Cosgrove D, Dietrich CF, Fromageau J, Bojunga J, Calliada F, Cantisani V, Correas JM, D'Onofrio M, Drakonaki EE, Fink M, Friedrich-Rust M, Gilja OH, Havre RF, Jenssen C, Klauser AS, Ohlinger R, Saftoiu A, Schaefer F, Sporea I, Piscaglia F |title=EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology |journal=Ultraschall Med |volume=34 |issue=2 |pages=169–84 |year=2013 |pmid=23558397 |doi=10.1055/s-0033-1335205 |url=}}</ref><ref name="pmid25911335">{{cite journal |vauthors= |title=EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis |journal=J. Hepatol. |volume=63 |issue=1 |pages=237–64 |year=2015 |pmid=25911335 |doi=10.1016/j.jhep.2015.04.006 |url=}}</ref><ref name="pmid21205132">{{cite journal |vauthors=Castera L, Bedossa P |title=How to assess liver fibrosis in chronic hepatitis C: serum markers or transient elastography vs. liver biopsy? |journal=Liver Int. |volume=31 Suppl 1 |issue= |pages=13–7 |year=2011 |pmid=21205132 |doi=10.1111/j.1478-3231.2010.02380.x |url=}}</ref><ref name="pmid23732714">{{cite journal |vauthors=Chou R, Wasson N |title=Blood tests to diagnose fibrosis or cirrhosis in patients with chronic hepatitis C virus infection: a systematic review |journal=Ann. Intern. Med. |volume=158 |issue=11 |pages=807–20 |year=2013 |pmid=23732714 |doi=10.7326/0003-4819-158-11-201306040-00005 |url=}}</ref><ref name="pmid26779260">{{cite journal |vauthors=Khallafi H, Qureshi K |title=Imaging Based Methods of Liver Fibrosis Assessment in Viral Hepatitis: A Practical Approach |journal=Interdiscip Perspect Infect Dis |volume=2015 |issue= |pages=809289 |year=2015 |pmid=26779260 |pmc=4686715 |doi=10.1155/2015/809289 |url=}}</ref><ref name="pmid23954643">{{cite journal |vauthors=Singh S, Fujii LL, Murad MH, Wang Z, Asrani SK, Ehman RL, Kamath PS, Talwalkar JA |title=Liver stiffness is associated with risk of decompensation, liver cancer, and death in patients with chronic liver diseases: a systematic review and meta-analysis |journal=Clin. Gastroenterol. Hepatol. |volume=11 |issue=12 |pages=1573–84.e1–2; quiz e88–9 |year=2013 |pmid=23954643 |pmc=3900882 |doi=10.1016/j.cgh.2013.07.034 |url=}}</ref> 
* The '''FibroScan (transient elastography)''' uses elastic waves to determine [[liver]] stiffness which theoretically may be converted into a liver score.
* The FibroScan produces an ultrasound image of the [[liver]] (from 20-80mm) along with a pressure reading (in kPa). 
* Transient elastography is much faster than a [[biopsy]] (usually lasts 2.5-5 minutes) and is completely painless.
* Findings on transient elastography may show reasonable correlation with the severity of cirrhosis:<ref>{{cite journal |author=Foucher J, Chanteloup E, Vergniol J, ''et al'' |title=Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study |journal=Gut |volume=55|issue=3 |pages=403-8 |year=2006 |pmid=16020491 |doi=10.1136/gut.2005.069153}}</ref><ref name="pmid22733854">{{cite journal |author=Xie L, Chen X, Guo Q, Dong Y, Guang Y, Zhang X |title=Real-time elastography for diagnosis of liver fibrosis in chronic hepatitis B |journal=[[Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine]] |volume=31 |issue=7 |pages=1053–60 |year=2012|pmid=22733854 |doi= |url=}}</ref>
** Increasing [[Scar|scarring]] of the [[liver]] is associated with increasing "stiffness" of the [[Tissue (biology)|tissue]].


==References==
==References==
{{reflist|2}}
{{reflist|2}}

Latest revision as of 15:04, 21 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Sudarshana Datta, MD [2]

Overview

In developing countries, liver biopsy is the gold standard test for the diagnosis of cirrhosis. The presence of bridging fibrous septa, parenchymal nodules bearing a mixture of replicating and sensecent hepatocytes and involvement of most or all of the liver are confirmatory of cirrhosis. Liver biopsy helps in confirmation of the diagnosis, determination of prognosis, underlying etiology, management of rejection subsequent to liver transplantation and evaluation of abnormal hepatic investigations. Sample of the liver may be obtained by Percutaneous, transjugular and laparoscopic radiographically- guided fine-needle approach. However, percutaneous liver biopsy is considered as the cornerstone of diagnosis. In developed countries, Fibroscan (transient elastography) is replacing liver biopsy as the gold standard diagnostic modality.

Diagnostic Study of Choice

Gold standard/Study of choice in developing countries:

Features of liver biopsy[1][2][3][4][5][6][7][8]

Gold standard/Study of choice in developed countries:

  • Fibroscan or transient elastography has now replaced liver biopsy as the gold standard diagnostic modality in developed countries.
  • Transient elastography and the Acoustic Radiation Force Impulse (ARFI) technique are well-established methods for the staging of fibrosis in cirrhosis: [13][14][15][16][17][18][19][20][21][22][23] 
  • The FibroScan (transient elastography) uses elastic waves to determine liver stiffness which theoretically may be converted into a liver score.
  • The FibroScan produces an ultrasound image of the liver (from 20-80mm) along with a pressure reading (in kPa).
  • Transient elastography is much faster than a biopsy (usually lasts 2.5-5 minutes) and is completely painless.
  • Findings on transient elastography may show reasonable correlation with the severity of cirrhosis:[24][25]

References

  1. ↑ Williams EJ, Iredale JP (1998). "Liver cirrhosis". Postgrad Med J. 74 (870): 193–202. PMC 2360862. PMID 9683971.
  2. ↑ Blomley MJ, Lim AK, Harvey CJ, Patel N, Eckersley RJ, Basilico R, Heckemann R, Urbank A, Cosgrove DO, Taylor-Robinson SD (2003). "Liver microbubble transit time compared with histology and Child-Pugh score in diffuse liver disease: a cross sectional study". Gut. 52 (8): 1188–93. PMC 1773750. PMID 12865280.
  3. ↑ Kim CK, Lim JH, Lee WJ (2001). "Detection of hepatocellular carcinomas and dysplastic nodules in cirrhotic liver: accuracy of ultrasonography in transplant patients". J Ultrasound Med. 20 (2): 99–104. PMID 11211142.
  4. ↑ Abdi W, Millan JC, Mezey E (1979). "Sampling variability on percutaneous liver biopsy". Arch. Intern. Med. 139 (6): 667–9. PMID 443970.
  5. ↑ Bedossa P, Dargère D, Paradis V (2003). "Sampling variability of liver fibrosis in chronic hepatitis C". Hepatology. 38 (6): 1449–57. doi:10.1016/j.hep.2003.09.022. PMID 14647056.
  6. ↑ Regev A, Berho M, Jeffers LJ, Milikowski C, Molina EG, Pyrsopoulos NT, Feng ZZ, Reddy KR, Schiff ER (2002). "Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection". Am. J. Gastroenterol. 97 (10): 2614–8. doi:10.1111/j.1572-0241.2002.06038.x. PMID 12385448.
  7. ↑ Bravo AA, Sheth SG, Chopra S (2001). "Liver biopsy". N. Engl. J. Med. 344 (7): 495–500. doi:10.1056/NEJM200102153440706. PMID 11172192.
  8. ↑ Rockey DC, Caldwell SH, Goodman ZD, Nelson RC, Smith AD (2009). "Liver biopsy". Hepatology. 49 (3): 1017–44. doi:10.1002/hep.22742. PMID 19243014.
  9. ↑ Cholongitas E, Quaglia A, Samonakis D, Senzolo M, Triantos C, Patch D, Leandro G, Dhillon AP, Burroughs AK (2006). "Transjugular liver biopsy: how good is it for accurate histological interpretation?". Gut. 55 (12): 1789–94. doi:10.1136/gut.2005.090415. PMC 1856467. PMID 16636018.
  10. ↑ Schirmacher P, Fleig WE, Tannapfel A, Langner C, Dries V, Terracciano L, Denk H, Dienes HP (2004). "[Bioptic diagnosis of chronic hepatitis. Results of an evidence-based consensus conference of the German Society of Pathology, of the German Society for Digestive and Metabolic Diseases and of Compensated Hepatitis (HepNet)]". Pathologe (in German). 25 (5): 337–48. doi:10.1007/s00292-004-0692-7. PMID 15278290.
  11. ↑ Tannapfel A, Dienes HP, Lohse AW (2012). "The indications for liver biopsy". Dtsch Arztebl Int. 109 (27–28): 477–83. doi:10.3238/arztebl.2012.0477. PMC 3402072. PMID 22833761.
  12. ↑ Grant, A (1999). "Guidelines on the use of liver biopsy in clinical practice". Gut. 45 (Suppl 4): 1–11. PMID 10485854. The main cause of mortality after percutaneous liver biopsy is intraperitoneal haemorrhage as shown in a retrospective Italian study of 68,000 percutaneous liver biopsies in which all six patients who died did so from intraperitoneal haemorrhage. Three of these patients had had a laparotomy, and all had either cirrhosis or malignant disease, both of which are risk factors for bleeding.
  13. ↑ Castera L, Pinzani M (2010). "Biopsy and non-invasive methods for the diagnosis of liver fibrosis: does it take two to tango?". Gut. 59 (7): 861–6. doi:10.1136/gut.2010.214650. PMID 20581229.
  14. ↑ Friedrich-Rust M, Nierhoff J, Lupsor M, Sporea I, Fierbinteanu-Braticevici C, Strobel D, Takahashi H, Yoneda M, Suda T, Zeuzem S, Herrmann E (2012). "Performance of Acoustic Radiation Force Impulse imaging for the staging of liver fibrosis: a pooled meta-analysis". J. Viral Hepat. 19 (2): e212–9. doi:10.1111/j.1365-2893.2011.01537.x. PMID 22239521.
  15. ↑ Friedrich-Rust M, Ong MF, Martens S, Sarrazin C, Bojunga J, Zeuzem S, Herrmann E (2008). "Performance of transient elastography for the staging of liver fibrosis: a meta-analysis". Gastroenterology. 134 (4): 960–74. doi:10.1053/j.gastro.2008.01.034. PMID 18395077.
  16. ↑ Ziol M, Handra-Luca A, Kettaneh A, Christidis C, Mal F, Kazemi F, de Lédinghen V, Marcellin P, Dhumeaux D, Trinchet JC, Beaugrand M (2005). "Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with chronic hepatitis C". Hepatology. 41 (1): 48–54. doi:10.1002/hep.20506. PMID 15690481.
  17. ↑ Sandrin L, Fourquet B, Hasquenoph JM, Yon S, Fournier C, Mal F, Christidis C, Ziol M, Poulet B, Kazemi F, Beaugrand M, Palau R (2003). "Transient elastography: a new noninvasive method for assessment of hepatic fibrosis". Ultrasound Med Biol. 29 (12): 1705–13. PMID 14698338.
  18. ↑ Bamber J, Cosgrove D, Dietrich CF, Fromageau J, Bojunga J, Calliada F, Cantisani V, Correas JM, D'Onofrio M, Drakonaki EE, Fink M, Friedrich-Rust M, Gilja OH, Havre RF, Jenssen C, Klauser AS, Ohlinger R, Saftoiu A, Schaefer F, Sporea I, Piscaglia F (2013). "EFSUMB guidelines and recommendations on the clinical use of ultrasound elastography. Part 1: Basic principles and technology". Ultraschall Med. 34 (2): 169–84. doi:10.1055/s-0033-1335205. PMID 23558397.
  19. ↑ "EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis". J. Hepatol. 63 (1): 237–64. 2015. doi:10.1016/j.jhep.2015.04.006. PMID 25911335.
  20. ↑ Castera L, Bedossa P (2011). "How to assess liver fibrosis in chronic hepatitis C: serum markers or transient elastography vs. liver biopsy?". Liver Int. 31 Suppl 1: 13–7. doi:10.1111/j.1478-3231.2010.02380.x. PMID 21205132.
  21. ↑ Chou R, Wasson N (2013). "Blood tests to diagnose fibrosis or cirrhosis in patients with chronic hepatitis C virus infection: a systematic review". Ann. Intern. Med. 158 (11): 807–20. doi:10.7326/0003-4819-158-11-201306040-00005. PMID 23732714.
  22. ↑ Khallafi H, Qureshi K (2015). "Imaging Based Methods of Liver Fibrosis Assessment in Viral Hepatitis: A Practical Approach". Interdiscip Perspect Infect Dis. 2015: 809289. doi:10.1155/2015/809289. PMC 4686715. PMID 26779260.
  23. ↑ Singh S, Fujii LL, Murad MH, Wang Z, Asrani SK, Ehman RL, Kamath PS, Talwalkar JA (2013). "Liver stiffness is associated with risk of decompensation, liver cancer, and death in patients with chronic liver diseases: a systematic review and meta-analysis". Clin. Gastroenterol. Hepatol. 11 (12): 1573–84.e1–2, quiz e88–9. doi:10.1016/j.cgh.2013.07.034. PMC 3900882. PMID 23954643.
  24. ↑ Foucher J, Chanteloup E, Vergniol J; et al. (2006). "Diagnosis of cirrhosis by transient elastography (FibroScan): a prospective study". Gut. 55 (3): 403–8. doi:10.1136/gut.2005.069153. PMID 16020491.
  25. ↑ Xie L, Chen X, Guo Q, Dong Y, Guang Y, Zhang X (2012). "Real-time elastography for diagnosis of liver fibrosis in chronic hepatitis B". Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine. 31 (7): 1053–60. PMID 22733854.
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