KASL clinical practice guidelines for noninvasive tests to assess liver fibrosis in chronic liver disease

doi:10.3350/cmh.2024.0506

Practice Guideline

. 2024 Sep;30(Suppl):S5-S105.

doi: 10.3350/cmh.2024.0506. Epub 2024 Aug 19.

KASL clinical practice guidelines for noninvasive tests to assess liver fibrosis in chronic liver disease

Mi Na Kim^{1

2}, Ji Won Han³, Jihyun An⁴, Beom Kyung Kim^{1

2}, Young-Joo Jin⁵, Seung-Seob Kim⁶, Minjong Lee⁷, Han Ah Lee⁸, Yuri Cho⁹, Hee Yeon Kim¹⁰, Yu Rim Shin¹¹, Jung Hwan Yu⁵, Moon Young Kim¹², YoungRok Choi¹³, Young Eun Chon¹⁴, Eun Ju Cho¹⁵, Eun Joo Lee¹⁶, Sang Gyune Kim¹⁷, Won Kim¹⁸, Dae Won Jun¹⁹, Seung Up Kim^{1

2}; Korean Association for the Study of the Liver (KASL)

Affiliations

¹ Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
² Yonsei Liver Center, Severance Hospital, Seoul, Korea.
³ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
⁴ Department of Gastroenterology and Hepatology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.
⁵ Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea.
⁶ Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
⁷ Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea.
⁸ Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
⁹ Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea.
¹⁰ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
¹¹ Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea.
¹² Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
¹³ Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
¹⁴ Department of Internal Medicine, Institute of Gastroenterology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
¹⁵ Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
¹⁶ Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
¹⁷ Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
¹⁸ Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
¹⁹ Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea.

PMID: 39159947
PMCID: PMC11493350
DOI: 10.3350/cmh.2024.0506

Practice Guideline

KASL clinical practice guidelines for noninvasive tests to assess liver fibrosis in chronic liver disease

Mi Na Kim et al. Clin Mol Hepatol. 2024 Sep.

. 2024 Sep;30(Suppl):S5-S105.

doi: 10.3350/cmh.2024.0506. Epub 2024 Aug 19.

Authors

Affiliations

¹ Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
² Yonsei Liver Center, Severance Hospital, Seoul, Korea.
³ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
⁴ Department of Gastroenterology and Hepatology, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.
⁵ Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea.
⁶ Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
⁷ Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea.
⁸ Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
⁹ Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea.
¹⁰ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
¹¹ Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea.
¹² Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
¹³ Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
¹⁴ Department of Internal Medicine, Institute of Gastroenterology, CHA Bundang Medical Center, CHA University, Seongnam, Korea.
¹⁵ Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
¹⁶ Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
¹⁷ Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea.
¹⁸ Department of Internal Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
¹⁹ Department of Internal Medicine, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea.

PMID: 39159947
PMCID: PMC11493350
DOI: 10.3350/cmh.2024.0506

No abstract available

Keywords: Chronic liver disease; Guidelines; Liver fibrosis; Noninvasive test.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest

Conflicts of interest statement is available at the official website of Clinical and Molecular Hepatology (Supplementary Table 2, https://doi.org/10.3350/cmh.2024.0506).

Figures

**Figure 1.**
Principles of vibration-controlled transient elastography [43].

**Figure 2.**
Principles of point shear wave elastography (A) and actual images (B).

**Figure 3.**
Principles of two-dimensional shear wave elastography (A) and actual images (B).

**Figure 4.**
Principles of magnetic resonance elastography.

**Figure 5.**
Examples of actual magnetic resonance elastography images. MMDI, multimodel direct inversion algorithm.

**Figure 6.**
Antiviral therapy algorithm for chronic hepatitis B patients in the gray zone. HBsAg, hepatitis B surface antigen; HBeAg, hepatitis B e antigen; HBV, hepatitis B virus; ALT, alanine aminotransferase; AST, aspartate aminotransferase; VCTE, vibration-controlled transient elastography; MRE, magnetic resonance elastography.

**Figure 7.**
Algorithm for screening high-risk groups of patients with nonalcoholic fatty liver disease. T2DM, type 2 diabetes mellitus; HBV, hepatitis B virus; HCV, hepatitis C virus; FIB-4, fibrosis-4 index; VCTE, vibration-controlled transient elastography; LS, liver stiffness; MRE, magnetic resonance elastography; ELF, enhanced liver fibrosis; NITs, non-invasive tests.

See this image and copyright information in PMC

References

1. Rockey DC, Caldwell SH, Goodman ZD, Nelson RC, Smith AD, American Association for the Study of Liver Diseases Liver biopsy. Hepatology. 2009;49:1017–1044. - PubMed
1. Poynard T, Munteanu M, Imbert-Bismut F, Charlotte F, Thabut D, Le Calvez S, et al. Prospective analysis of discordant results between biochemical markers and biopsy in patients with chronic hepatitis C. Clin Chem. 2004;50:1344–1355. - PubMed
1. Rosenberg WM, Voelker M, Thiel R, Becka M, Burt A, Schuppan D, et al. Serum markers detect the presence of liver fibrosis: a cohort study. Gastroenterology. 2004;127:1704–1713. - PubMed
1. Anstee QM, Castera L, Loomba R. Impact of non-invasive biomarkers on hepatology practice: past, present and future. J Hepatol. 2022;76:1362–1378. - PubMed
1. Lee Y, Bae S, Kim JH, Kwak M, Jeon SY, Kim T, et al. Diagnostic efficacy of serum asialo α1-acid glycoprotein levels for advanced liver fibrosis and cirrhosis in patients with chronic hepatitis B compared to that in healthy subjects: a prospective study. J Clin Med. 2023;12:712. - PMC - PubMed

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[1] Rockey DC, Caldwell SH, Goodman ZD, Nelson RC, Smith AD, American Association for the Study of Liver Diseases Liver biopsy. Hepatology. 2009;49:1017–1044. - PubMed

[2] Rockey DC, Caldwell SH, Goodman ZD, Nelson RC, Smith AD, American Association for the Study of Liver Diseases Liver biopsy. Hepatology. 2009;49:1017–1044. - PubMed

[3] Poynard T, Munteanu M, Imbert-Bismut F, Charlotte F, Thabut D, Le Calvez S, et al. Prospective analysis of discordant results between biochemical markers and biopsy in patients with chronic hepatitis C. Clin Chem. 2004;50:1344–1355. - PubMed

[4] Poynard T, Munteanu M, Imbert-Bismut F, Charlotte F, Thabut D, Le Calvez S, et al. Prospective analysis of discordant results between biochemical markers and biopsy in patients with chronic hepatitis C. Clin Chem. 2004;50:1344–1355. - PubMed

[5] Rosenberg WM, Voelker M, Thiel R, Becka M, Burt A, Schuppan D, et al. Serum markers detect the presence of liver fibrosis: a cohort study. Gastroenterology. 2004;127:1704–1713. - PubMed

[6] Rosenberg WM, Voelker M, Thiel R, Becka M, Burt A, Schuppan D, et al. Serum markers detect the presence of liver fibrosis: a cohort study. Gastroenterology. 2004;127:1704–1713. - PubMed

[7] Anstee QM, Castera L, Loomba R. Impact of non-invasive biomarkers on hepatology practice: past, present and future. J Hepatol. 2022;76:1362–1378. - PubMed

[8] Anstee QM, Castera L, Loomba R. Impact of non-invasive biomarkers on hepatology practice: past, present and future. J Hepatol. 2022;76:1362–1378. - PubMed

[9] Lee Y, Bae S, Kim JH, Kwak M, Jeon SY, Kim T, et al. Diagnostic efficacy of serum asialo α1-acid glycoprotein levels for advanced liver fibrosis and cirrhosis in patients with chronic hepatitis B compared to that in healthy subjects: a prospective study. J Clin Med. 2023;12:712. - PMC - PubMed

[10] Lee Y, Bae S, Kim JH, Kwak M, Jeon SY, Kim T, et al. Diagnostic efficacy of serum asialo α1-acid glycoprotein levels for advanced liver fibrosis and cirrhosis in patients with chronic hepatitis B compared to that in healthy subjects: a prospective study. J Clin Med. 2023;12:712. - PMC - PubMed

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KASL clinical practice guidelines for noninvasive tests to assess liver fibrosis in chronic liver disease

Affiliations

KASL clinical practice guidelines for noninvasive tests to assess liver fibrosis in chronic liver disease

Authors

Affiliations

Conflict of interest statement

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