Liver Disease Diagnosis & Treatment
Liver fibrosis can result from various types of chronic damage to the liver including infections, toxins, autoimmune disorders as well as cholestatic and metabolic diseases. Cirrhosis, the end stage of fibrosis, affects millions of people worldwide. Liver fibrosis is currently staged using needle biopsy, a highly invasive procedure with a number of disadvantages . These include potential morbidity and mortality, as well as sus- ceptibility to inter-observer variability and sampling error. Finally, repeat biopsies are not well-tolerated and therefore not suitable for monitoring disease progression. It is well-known that liver stiffness increases with the progression of fibrosis. In recent years, there has been increasing interest in liver stiffness as a marker for hepatic fibrosis. Fatty change is when fat builds up in your liver cells. It can be used alone or with other tests (such as blood tests, imaging scans, or biopsies) that also measure scarring or fatty change in your liver).
Fibroscan is a non-invasive test that helps assess the health of your liver. Specifically, it uses ultrasound technology to determine the degree of fibrosis or scarring that may be present in your liver from various liver diseases or conditions. This information is then used by your gastroenterologist to individualize and optimize your treatment plan. For some patients, Fibroscan can replace liver biopsy. FibroScan test results are used in conjunction with other clinical data, laboratory test results, and liver imaging in managing individual patients.
The risks
The FibroScan test is a completely non-invasive, simple and painless procedure that takes approximately 10 minutes to complete. Most patients with chronic liver disease can be assessed, but the test is not recommended or interpretable in patients with:
- Fluid in the abdomen (i.e. ascites, variceal bleeding or hepatic encephalopathy)
- Acute hepatitis
- Right heart failure
- Severe obesity
- Small rib spaces
- Inability to lie flat
The preparation
Patients are asked to wear loose clothing and should be able to lie flat on an exam table for 10 minutes or more while the test is being performed. Patients are asked not to consume any liquids or solids for a minimum of 3 hours before the test to increase the likelihood of obtaining reliable test results. The scan typically takes 10 to 15 minutes to complete, but patients should plan on being here for 30 minutes to allow time for preparation.
The procedure
The liver is located in the right upper abdomen under the rib cage. Patients are asked to lie flat on an examination table. A technician places the FibroScan probe between the ribs on the right side of the lower chest wall. A series of painless pulses are then applied to the liver. The results are recorded on the equipment and an overall liver stiffness score is generated. This score is then interpreted by a qualified physician to predict the likelihood of advanced fibrosis or cirrhosis.
After the procedure
It is not necessary to bring a driver for your liver elastography appointment. After the procedure, you will be immediately discharged from the procedure area and be able to leave without any restrictions. FibroScan results will be available in about one to two weeks.
The test measures the extent of steatosis (fatty inflammation) and fibrosis (scar tissue in liver which may lead to cirrhosis which might lead to liver failure) of the liver.
STEATOSIS
FibroScan steatosis result (CAP score): _______________ decibels per meter (dB/m)
Steatosis grade: _______________
Your CAP score is a measurement of fatty change in your liver. Your healthcare provider will use your CAP score to find out your steatosis grade.
The CAP score is measured in decibels per meter (dB/m). It ranges from 100 to 400 dB/m. The table below shows ranges of CAP scores and the matching steatosis grade and amount of fatty change.
| CAP Score | Steatosis Grade | Amount of Liver with Fatty Change |
| 238 to 260 dB/m | S1 | 11% to 33% |
| 260 to 290 dB/m | S2 | 34% to 66% |
| Higher than 290 dB/m | S3 | 67% or more |
Fibrosis
FibroScan fibrosis result: _______________ kilopascals (kPa)
Fibrosis score: _______________
Your fibrosis result is a measurement of the amount of scarring in your liver. FibroScan measures scarring by measuring the stiffness of your liver.
The fibrosis result is measured in kilopascals (kPa) It’s normally between 2 and 6 kPa. The highest possible result is 75 kPa. Many people with liver disease(s) have a result that’s higher than the normal range.
Your healthcare provider will use your FibroScan fibrosis result and your medical history to determine your fibrosis score.
- Fibrosis score F0 to F1: No liver scarring or mild liver scarring
- Fibrosis score F2: Moderate liver scarring
- Fibrosis score F3: Severe liver scarring
- Fibrosis score F4: Advanced liver scarring (cirrhosis)
Using your FibroScan fibrosis result to estimate your fibrosis score
The table below shows liver diseases, ranges of fibrosis results, and the matching fibrosis score. The ranges of fibrosis results in the table are estimates. This means that your actual fibrosis score (the score that your healthcare provider tells you) may not match the fibrosis score in the table. If you have more than one liver disease, you may not be able to use the table.
To use the table, find the liver disease that you have on the left side of the table. Read across the row from left to right until you find the range that includes your fibrosis result. Then, look at the top of that column to see the fibrosis score.
| F0 to F1 | F2 | F3 | F4 | |
| Hepatitis B | 2 to 7 kPa | 8 to 9 kPa | 8 to 11 kPa | 18 kPa or higher |
| Hepatitis C | 2 to 7 kPa | 8 to 9 kPa | 9 to 14 kPa | 14 kPa or higher |
| HIV/HCV Coinfection | 2 to 7 kPa | 7 to 11 kPa | 11 to 14 kPa | 14 kPa or higher |
| Cholestatic Disease | 2 to 7 kPa | 7 to 9 kPa | 9 to 17 kPa | 17 kPa or higher |
| Non-Alcoholic Fatty Liver Disease (NAFLD or NASH) | 2 to 7 kPa | 7.5 to 10 kPa | 10 to 14 kPa | 14 kPa or higher |
| Alcohol Related Disease | 2 to 7 kPa | 7 to 11 kPa | 11 to 19 kPa | 19 kPa or higher |
Limitations
Your fibrosis result may be overestimated (your liver may have less scarring than what your fibrosis result says) if you have:
- Liver inflammation. This can be caused by a recent liver illness or drinking alcohol.
- Benign (not cancerous) or cancerous tumors in your liver.
- Liver congestion (when your liver is too full of blood or other fluids). This is usually caused by heart failure.
Your FibroScan results may also be less accurate if you have:
- A body mass index (BMI) higher than 30 (obesity)
- A build-up of fluid in your abdomen (ascites)
- Too little bile flowing out of your liver (biliary obstruction)