CONFRONTO TRA METODICHE NON INVASIVE E AGOBIOPSIA EPATICA NELLA VALUTAZIONE DELLA FIBROSI EPATICA NELLE EPATITI CRONICHE VIRALI: SENSIBILITA' E SPECIFICITA' DELLA FIBROELASTOMETRIA EPATICA COME TECNICA DI IMAGING

Infections with hepatitis B and C are among the most frequent causes of chronic liver disease and lead to serious complications such as cirrhosis and hepatocellular carcinoma. The latter is related to factors such as age, viremia, severity of liver disease and geographical factors and the risk of cancer increases if there is even cirrhosis. Chronic liver infection triggers a series of responses and activates various mechanisms that, in the long period of time the disease acts, lead to fibrosis, which can be interpreted as a true indicator of the clinical and functional organ. The prognosis and clinical management of patients with chronic liver disease are largely influenced by the accumulation of fibrosis and its progression over time and the same treatment choices are influenced by this parameter. Early identification of injuries and reliable enough to enable rapid and correct treatment approach is the main goal of modern imaging. For years, liver biopsy is the only tool for assessing fibrosis. However, the biopsy is an invasive procedure which can sometimes be painful and cause complications and that can discourage some people to undergo this evaluation. In this context, there is between the imaging techniques measurement of liver fibrosis by fibroelastometria pulse (Fibroscan) that allows to determine non-invasively the extent of fibrosis and allows to see by its accuracy the fibrosis evolution over time . The examination Fibroscan involves applying a small mechanical impulse to the skin by placing a modified ultrasound probe at the level of an intercostal space above the liver parenchyma on the right side. The tool scans, through a beam of ultrasonic waves, induced mechanical wave velocity and calculates a numerical index, expressed in kilopascals (kPa), assessing liver fibrosis. The speed of propagation of mechanical waves passing through the liver is proportional to the rigidity of the organ: the more rigid the liver is the faster the wave propagates. In our study Fibroscan and the biochemical marker FIB4 are useful tests to identify especially patients with cirrhosis without performing a liver biopsy. However, for the clinical evaluation of most patients with mild-moderate fibrosis, biopsy remains the technique of choice.