Recent advances in the non-invasive assessment of liver fibrosis based on serum biomarkers and imaging have been summarized in reviews. In the first-line screening, serum biomarkers are used to exclude patients with low risk of advanced fibrosis, and, in the second-line screening, patients with advanced fibrosis are identified by elastography. Blood tests are also widely used to evaluate liver fibrosis and prognosis in patients with chronic hepatitis, and a two-step screening strategy to detect advanced fibrosis patients in a large population has been suggested. Although elastography has a high diagnostic ability for not only liver fibrosis but also liver steatosis and is widely used, it has a number of drawbacks, such as the requirement of expensive equipment, limited available facilities, and equipment incompatibility. Therefore, various methods for the evaluation of noninvasive liver fibrosis have been developed recently, including elastography using magnetic resonance imaging or ultrasonography. Although liver biopsy is currently the gold standard for liver fibrosis evaluation, it has many drawbacks, such as risk of complications and difficulty in repeated evaluation. Liver fibrosis correlates with hepatocarcinogenesis and prognosis in chronic liver diseases hence, an accurate evaluation of liver fibrosis is extremely important.
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