A doctor’s evaluation
Sometimes blood tests, imaging tests, or both
Sometimes liver biopsy
Doctors suspect fibrosis when people have a disorder or take a drug that could cause fibrosis or when routine blood tests to evaluate the liver Liver Blood Tests Liver tests are blood tests that represent a noninvasive way to screen for the presence of liver disease (for example, hepatitis in donated blood) and to measure the severity and progress of… read more indicate that the liver is damaged or is malfunctioning. Tests are then done to confirm the diagnosis, and if fibrosis is present, tests are done to determine its severity. These tests can include imaging tests, blood tests, liver biopsy, and sometimes specialized imaging tests to determine how stiff the liver is.
Certain combinations of blood tests can distinguish between two levels of fibrosis:
Absent or mild
Moderate to severe
These tests cannot reliably differentiate between degrees of moderate or severe fibrosis. The severity of fibrosis helps indicate the prognosis in people who have chronic viral hepatitis.
Liver biopsy Biopsy of the Liver Doctors can obtain a sample of liver tissue during exploratory surgery, but more often they obtain a sample by inserting a hollow needle through the person’s skin and into the liver. This type… read more is the most reliable way to detect and stage (determine the amount of) fibrosis and to identify the disorder causing fibrosis. Biopsy is often done to confirm the diagnosis, to identify the cause of the liver disease, to stage the level of fibrosis or the presence of cirrhosis, as well as to assess the response to the treatment. Because liver biopsy is invasive and can cause complications, doctors may first do blood tests and imaging tests to determine the level of fibrosis and then decide about the need for a liver biopsy. Doctors are increasingly relying on certain specialized imaging tests as noninvasive alternatives to biopsy.
Specialized imaging tests can determine how stiff the liver is. The stiffer liver tissue is, the more severe fibrosis is likely to be. These tests (transient elastography, magnetic resonance elastography, and acoustic radiation force impulse imaging) use sound waves, applied to the abdomen, to determine how stiff the liver tissue is. Unlike liver biopsy, these tests are not invasive and thus have some advantage. Transient elastography and magnetic resonance elastography are being used in people with various liver disorders to diagnose and stage the fibrosis. Additionally, these tests are used to assess the amount of liver fat in people with fatty liver disease. Conventional ultrasonography can be unreliable because results depend on the skill of the person doing the procedure. In contrast, these specialized imaging tests report their measurement in numbers, allowing objective assessment.