Non invasive tools for the diagnosis of liver cirrhosis

Liver cirrhosis (LC), the end stage of many forms of chronic hepatitis of different etiologies is a diffuseprocess characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules surrounded by annular fibrosis. This chronicprogressive clinical condition, leads to liver cell failure and portal hypertension, which can favour the onset of hepatocellular carcinoma. Defining the phase of the natural history is crucial for therapeutic choice and prognosis. Liver biopsy is currently considered thebest available standard of reference but it has some limits, so alternative tools have been developed to substitute liver biopsy when assessing liver fibrosis.Serum markers offer a cost-effective alternative to liver biopsy being less invasive and theoretically withoutcomplications. They can be classified into direct and indirect markers which may be used alone or in combination to produce composite scores. Diagnosticimaging includes a number of instruments and techniques to estimate liver fibrosis and cirrhosis likeultrasound (US), US Doppler, contrast enhanced US and Elastography. US could be used for the diagnosis ofadvanced LC while is not able to evaluate progression of fibrosis, in this case Elastography is more reliable.This review aims to revise the most recent data from the literature about non invasive methods useful indefining liver fibrosis.