Illustration of a healthy liver with golden threads representing non-invasive assessment technology.

Beyond the Biopsy: Exploring Non-Invasive Liver Fibrosis Assessment

Lena Kashyap in Health & Wellness December 2025 • 4 min read.

"Discover how new, low-cost techniques are changing the way we monitor liver health, offering hope and convenience for patients worldwide."

In recent decades, significant advancements in treating major hepatitis viruses have been made, particularly Hepatitis B virus (HBV). Vaccination programs have led to complete immunization in many countries, reducing the rate of viral hepatitis. However, the landscape of chronic liver diseases (CLD) is evolving, with a growing epidemic of metabolic disorders such as non-alcoholic fatty liver disease (NAFLD) and steatohepatitis (NASH), alongside toxic disorders, particularly alcohol-related issues.

These diverse causes of CLD share a common histopathological pathway: the formation and accumulation of fibrosis. Over time, this process can progress, leading to nodule formation, distortion of the hepatic architecture, and ultimately cirrhosis. Liver biopsy has long been the gold standard for evaluating hepatic fibrosis, providing valuable insights into inflammation, necrosis, steatosis, and the presence of iron and copper within the liver parenchyma.

To assess inflammation and stage liver fibrosis, various scoring systems have been developed, such as the METAVIR system, which distinguishes five degrees of fibrosis. However, liver biopsy is not without its drawbacks. It is an expensive procedure with potential complications, including bleeding, pain, infection, and accidental injury to nearby organs. These limitations have spurred research into optimizing non-invasive markers of fibrosis.

Non-Invasive Assessment of Liver Fibrosis: A New Era in Liver Health

Illustration of a healthy liver with golden threads representing non-invasive assessment technology.

Two primary non-invasive approaches are used to evaluate liver fibrogenesis activity and fibrosis stage. Direct markers of fibrogenesis reflect the deposition or removal of extracellular matrix in the liver, while indirect markers indicate liver changes induced by fibrosis without a direct link to fibrogenetic mechanisms. Direct markers include glycoproteins like hyaluronic acid and laminin, collagen family members like type IV collagen, and various cytokines.

However, because fibrosis isn't exclusive to the liver, these markers can be influenced by clearance and excretion changes, as well as fibrotic processes in other organs. The second approach involves using single or combined hematological or biochemical tests that reflect changes in liver function. Examples include platelet count, the aspartate/alanine aminotransferase (AST/ALT) ratio, and the AST/platelets ratio (APRI). The accuracy of these indirect markers varies, making it challenging to evaluate the degree of liver fibrosis effectively.

Direct Markers: Glycoproteins (hyaluronic acid, laminin), collagens (type IV, type III), matrix metalloproteinases, cytokines.
Indirect Markers: Platelet count, AST/ALT ratio, APRI.

More sophisticated methods include biochemical scores or biomarker panels generated through statistical methods, such as Fibrotest, Forns' index, Hepascore, and Enhanced Liver Fibrosis Test. While these panels reliably exclude or detect significant fibrosis, they often struggle to reflect small changes in the early stages of fibrosis.

The Future of Liver Health Assessment

Considering its ease of use, speed, and low cost, the combined ultrasonography-GLQ approach deserves attention. Future prospective studies should evaluate the GLQ's applicability in large cohorts of patients with CLD, divided by etiologies, to determine its potential as a valuable tool in liver health management.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.23736/s0031-0808.18.03444-4, Alternate LINK

Title: Non-Invasive Assessment Of Liver Fibrosis: Exploring The Opportunity For A Low-Cost Approach Using The Genoa Line Quantification

Subject: General Medicine

Journal: Panminerva Medica

Publisher: Edizioni Minerva Medica

Authors: Andrea Marengo

Published: 2018-09-01

Everything You Need To Know

Why is there a move towards non-invasive methods for liver fibrosis assessment?

Liver fibrosis assessment has traditionally relied on liver biopsies, an invasive procedure that, while informative, carries risks such as bleeding, pain, and infection. Liver biopsy can also be expensive. These drawbacks have led to the development of non-invasive methods for assessing liver fibrosis.

What are direct markers of liver fibrogenesis, and what are their limitations?

Direct markers in liver fibrosis assessment reflect the actual deposition or removal of extracellular matrix in the liver. They include substances like glycoproteins such as hyaluronic acid and laminin, collagen family members like type IV collagen, various cytokines, and matrix metalloproteinases. However, these markers aren't exclusive to the liver, which means changes in their levels can be influenced by processes outside the liver. So direct markers can be affected by clearance and excretion changes, or by fibrotic processes in other organs.

What are indirect markers of liver fibrogenesis, and why are they used?

Indirect markers in liver fibrosis assessment involve using simple blood tests that reflect changes in liver function, such as platelet count, the aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio, and the AST/platelets ratio (APRI). These markers are readily available and inexpensive. However, their accuracy in determining the degree of liver fibrosis varies, making it challenging to get a precise understanding of the extent of liver damage.

What is Genoa Line Quantification (GLQ), and why is it important?

The Genoa Line Quantification, or GLQ, is a non-invasive approach used in combination with ultrasonography to assess liver health. It is favored for its ease of use, speed, and low cost. It is used to monitor fibrosis. Further studies are needed to evaluate its applicability in diverse groups of patients with chronic liver disease, to determine its potential as a valuable tool in liver health management.

What are scoring systems like METAVIR used for in the context of liver fibrosis?

Scoring systems like the METAVIR system are used to assess inflammation and stage liver fibrosis. The METAVIR system, for instance, distinguishes five degrees of fibrosis. This allows doctors to grade the severity of the condition, from mild to severe. METAVIR is very useful for guiding treatment decisions and monitoring disease progression in patients with liver conditions.