# Quantification of Liver Fibrosis--A Comparative Study
## 3 Literature Review
### Aim of Study
#### 3.1.2 Comparison of Biopsy Imaging with Non-Invasive Imaging Modalities  
In [PERSON] et al. [35], the FibroTest biomarker was validated in alcoholic liver disease (ALD) patients who also had chronic viral hepatitis. They aimed for comparing the diagnostic and prognostic values of FibroTest against other well-known biomarkers, including FibrometerA and Hepascore. [PERSON] et al. [36] compared the performance of several liver fibrosis biomarkers, developed for CHC (Hepascore, FibroTest, APRI) with the METAVIR fibrosis staging system and the image analysis CPA calculation.  
Although the new quantitative DIA technology was successfully applied to the assessment of liver fibrosis in chronic viral hepatitis patients, its clinical use was usually limited to specialized centers. As a solution, [PERSON] et al. [37] proposed the use of well-known and easily accessible hardware and software tools to perform CPA calculations based on image analysis techniques. [PERSON] et al. [38] considered also the validation of an inexpensive DIA technique for fibrosis quantification in patients with CHB.  
The following studies took into account an extra medical imaging modality for the diagnosis of hepatic diseases, namely the liver stiffness measurement (LSM), which can be integrated in an ultrasound or magnetic resonance (MR) machine. Initially, [PERSON] et al. [39] aimed at assessing the diagnostic accuracy of a multiparametric-MR method for liver tissue characterization, along with fibrosis, steatosis and iron quantification. In a later stage, they conducted a comparison of the proposed MR technique against transient elastography (TE) and the gold standard of liver biopsy. [PERSON] et al. [40], chose the CPA to detect the expansion of fibrosis at the very early stages after liver transplantation. Based on this preference, their work aimed to evaluate whether sinusoidal fibrosis (SF) in early liver biopsies represents an early and accurate marker for identifying patients with severe HCV recurrence after LT. For [PERSON] et al. [41], their goal was to compare the diagnostic performances of CPA and LSM in chronic hepatitis C biopsy specimens. This comparison would determine the liver fibrosis quantification by using the CPA and would in parallel focus on the necorinlammatory effects of liver stiffness (LS).  
In [PERSON] et al. [42], the main purpose of the study was to investigate the relationship between liver stiffness measured with the point shear wave elastography (PSWE) technology and the amount of collagen in CHB biopsy specimens based on digital computer image analysis. The objective of [PERSON] et al. [43] was to determine the diagnostic accuracy of transient elastography (TE) and real-time two-dimensional shear wave elastography (2D-SWE) techniques in ALD patients, based on liver biopsy, Ishak staging, and CPA determinations. [PERSON] et al. [44] recognized the contribution of recent advances in non-invasive fibrosis detection strategies, including serum markers, TE, and other elasticity-based radiological techniques. However, they chose the gold standard of liver biopsy to investigate the correlations between fibrosis density assessed by CPA and HVPG, in conjunction with the development of portal hypertension in chronic advanced ALD (cALD) patients.  
[PERSON] et al. [45] demonstrated the augmented mesenchymal stem cells' (MScs) ability to repair fibrotic livers in sodium nitroprusside (SNP) pretreated mice, as a consequence of nitric oxide (NO)-induced hepatic stellate cells (HScs) apoptosis. However, a necessary step was the quantification of fibrosis area, bilirubin, and alkaline phosphatase (ALP) before the onset of the proposed treatment method.