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We read with interest the recent reviews published in Gut, emphasising that even though the understanding of the pathobiology of liver fibrosis has been improved in the last three decades,1 novel and easy to implement diagnostic and therapeutic approaches are required.2 Indeed, fibrosis is the most important histological feature of patients with chronic liver disease (CLD), such as non-alcoholic fatty liver disease, and is associated with long-term overall mortality, liver transplantation and liver-related events.3 Diagnostic and therapeutic approaches,2 therefore, require accurate measurements that ideally allow non-invasive fibrosis quantification, representing the whole liver free of bias and easily integrated in clinical routine.
A liver biopsy, still the reference standard, has substantial drawbacks (complications, intraobserver and interobserver variabilities).4 Transient elastography (TE), suggested for population-wide screens (eg, patients with diabetes),5 requires additional expensive devices and trained personnel. However, contrast-enhanced MRI is routinely performed and recommended in patients with CLD for exclusion of hepatocellular …
JAL and SK contributed equally.
JT and GMK contributed equally.
Contributors JAL, SK, JT and GMK: concept, design, planning, analysis and drafting of the letter. FT, FCS, AMS, DLRK, WB, FEU, RS, JG and HHS: analysis, recruitment and critical revision of the letter.
Competing interests None declared.
Ethics approval Ethics committee of the University of Bonn.
Provenance and peer review Not commissioned; internally peer reviewed.
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