Use of Liver Imaging and Biopsy in Clinical Practice.

Liver biopsies are traditionally performed to determine the cause and stage of liver disease, as well as to inform treatment decisions and determine prognosis. In 2001, Bravo et al. observed that “liver biopsy is usually the most specific test to assess the nature and severity of liver diseases.”1 During the past 16 years, however, the clinical use of liver biopsies has undergone a profound transformation. Validated alternatives to liver biopsy have proliferated, spurred by concerns about the costs of biopsy and the risk of complications. Furthermore, research has brought a new understanding of the limitations of liver biopsy. In this review, we discuss the role of liver biopsy in the current era, as well as the accuracy of noninvasive evaluations and their use in clinical practice for determining the cause of liver disease and focal liver lesions and for detecting advanced fibrosis and cirrhosis.