Assessing liver fibrosis without biopsy in patients with HCV or NAFLD

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Figure 1
Findings on liver biopsy in nonalcoholic fatty liver disease and hepatitis C virus infection.
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Figure 2
Algorithm to determine fibrosis stage for nonalcoholic fatty liver disease.

TABLE 1

Fibrosis staging systems for HCV and NAFLD

Stage	Ishak staging for HCV¹⁰	METAVIR staging for HCV¹¹	NASH Clinical Research Network staging system for NAFLD¹²
0	No fibrosis	No fibrosis	No fibrosis
1	Expansion of some portal areas with or without septa	Portal fibrosis without septa	Perisinusoidal or periportal fibrosis
2	Expansion of most portal areas with or without septa	Portal fibrosis with rare septa	Perisinusoidal and portal/periportal fibrosis
3	Expansion of most portal areas with occasional portal-portal bridging	Portal fibrosis with numerous septa	Bridging fibrosis
4	Expansion of portal areas with marked bridging (portal-portal, portal-central)	Cirrhosis	Cirrhosis
5	Marked bridging with occasional nodules (incomplete cirrhosis)
6	Cirrhosis

HCV = hepatitis C virus; METAVIR = Meta-analysis of Histological Data in Viral Hepatitis; NAFLD = nonalcoholic fatty liver disease; NASH = nonalcoholic steatohepatitis