![]() ![]() However, there are several well-known limitations, including sampling errors, subjective interpretation, semiquantitativeness, invasiveness, morbidity, and mortality of the procedure. Pathological confirmation of microscopic specimens obtained by ultrasound-guided needle biopsy is the reference standard for fibrosis staging. The METAVIR score is simple, reproducible, and clinically validated, while the Ishak score is generally considered to be unnecessarily complex but preferred in many clinical trials. The METAVIR score (F0: no fibrosis, F1: portal fibrosis without bridging fibrosis, F2: portal fibrosis with few bridging fibrosis, F3: bridging fibrosis with architectural distortion, F4: cirrhosis) and the Ishak score (grades four categories of activity/necrosis, 0-4 or 0-6) are commonly used systems for grading or staging. There are differences in the grading and scoring of fibrosis by microscopic pathology according to the cirrhosis pattern. Conversely, a centrizonal fibrosis pattern results from alcoholic and nonalcoholic steatohepatitis or chronic venous outflow obstruction. A portal-based pattern usually results from hepatitis B and C, autoimmune hepatitis, Wilson’s disease, primary biliary cirrhosis, primary sclerosing cholangitis, recurrent pyogenic cholangitis, and hemochromatosis. On the other hand, liver cirrhosis is classified according to the main location of fibrosis occurrence. Chronic hepatitis B is the most common cause of macronodular cirrhosis. In macronodular cirrhosis, the parenchymal nodules are larger, and more variable in size. This pattern is seen in chronic alcoholic, hepatitis C, and biliary cirrhosis. Micronodular cirrhosis is characterized by regenerative nodules of relatively uniform and small size. The gross morphologic appearance of a cirrhotic liver is categorized by the size of the parenchymal nodules: micronodular, macronodular, or mixed. As the inflammation persists, various form of fibrosis develops. Portal-central septa, connecting the portal vein and central vein, develop. Normal lobular architecture of the liver parenchyma is replaced by a parenchymal nodule surrounded by the fibrous tissue. These various etiologies induce chronic inflammation. There are a variety of causes of liver cirrhosis, with alcohol consumption, viruses, and fatty liver disease making up the majority of factors. Prognosis and management of chronic liver diseases hinge strongly on the amount and progression of liver fibrosis. Therefore, early diagnosis of liver cirrhosis and quantification of the proportion of fibrosis in the liver are very important in the management of chronic liver disease. Extensive scarring with parenchymal destruction is unlikely to regress. ![]() ![]() Regression is usually associated with the improvement of clinical status, but can vary in the degree of improvement, depending on the reversibility of liver damage. Recently, early liver cirrhosis was shown to be improved by regression of collagen tissue. In addition, the incidence of hepatocellular carcinoma is sharply increased. ![]() Liver cirrhosis reduces hepatic function and results in multiple complications induced by nodular regeneration and portal hypertension, including ascites, variceal bleeding, renal failure due to hepatorenal syndrome, hepatic encephalopathy, and spontaneous bacterial peritonitis. It is recognized as an irreversible form of parenchymal fibrosis. It is caused by diffuse fibrosis and regenerating nodules that result from recurrent necrosis of liver cell and degeneration. Liver cirrhosis is the end stage of chronic liver disease. Early diagnosis of liver cirrhosis using MRI or US elastography is therefore a realistic alternative, but further research is still needed. Amongst these methods, elastography using US and MRI was found to be slightly easier, faster, and able to provide an accurate diagnosis. There are a number of ways to compensate for this difficulty, including texture analysis to more closely identify the homogeneity of hepatic parenchyma, elastography to measure the stiffness and elasticity of the liver, and perfusion studies to determine the blood flow volume, transit time, and velocity. They are also accurate diagnostic methods for advanced liver cirrhosis, for which early diagnosis is difficult. Basic imaging for the diagnosis of liver cirrhosis has developed over the last few decades, enabling early detection of morphological changes of the liver by ultrasonography (US), computed tomography, and magnetic resonance imaging (MRI). However, its invasiveness and sampling bias limit the applicability of the method. Ultrasound-guided liver biopsy is the gold standard for diagnosis of liver cirrhosis. Early diagnosis of liver cirrhosis is important. ![]()
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