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Liver fibrosis, that is, excessive accumulation of extracellular matrix protein, occurs and is the wound-healing response and common final pathway of various chronic liver diseases. Advanced hepatic fibrosis caused by chronic liver inflammation eventually progresses to cirrhosis, and prognosis and management of chronic liver diseases depend on the fibrotic severities. Therefore, the early and precise evaluation of severity and status of liver fibrosis provides useful information for diagnosis as well as treatment planning and treatment efficacy and prognosis. Although invasive liver biopsy is the gold standard to assess the nature and severity of hepatic fibrosis, it has several recognized limitations including sampling error and inter-observer variability in interpretation and staging. Furthermore, the dynamic process of fibrosis resulting from progression and regression is difficult to capture with biopsy alone. Therefore, alternative, simple, reliable, and noninvasive direct and indirect serummarkers able to predict the presence of significant fibrosis or cirrhosis in patients with chronic liver disease with considerable accuracy were needed. The hepatology experts are actively researching noninvasive methods of fibrosis quantification. The aims of this chapterwere to review the nature and limitations of the several noninvasivemethods for the assessment of presence and severity of liver fibrosis in patients with chronic liver disease.

Noninvasive Diagnostic and Prognostic Assessment Tools for Liver Fibrosis and Cirrhosis in Patients with Chronic Liver Disease