Hey all, I am in Canada and had a fibroscan done back in May. Before I get into that a quick background. I was diagnosed with Alcholic fatty liver in March. I had an ultrasound that showed this. My enzymes were slightly raised at that time. Since then my enzymes have returned to normal and my de ritis ratio has dropped so far down to a 1.3:1. I had a second ultrasound in may that showed that there still is a bit of fat left. But stated no lesions or course echo texture was found. Now a week after that second ultra sound I had a fibroscan and the results showed an S0 for no fatty liver and a kpa score of 58! I now know that you cannot eat or drink liquid before a fibroscan but was told by the operator that liquid at anytime was fine. So i had a bottle of water and 2 extra large teas with milk and sugar right up to the moment she did the test. Is it possible that the residual inflammation from liver and the liquid before the test could have skewed the kpa results? Also that it showed a S0 for fatty liver when both ultrasounds clearly depict it??? I currently have absolutely no symptoms of cirrhosis and bloods are perfect aside of platelets which is part of a different issue.
Another Fibroscan Question.: Hey all, I... - British Liver Trust
Another Fibroscan Question.
Some water and a couple of cups of tea would only have a very marginal effect on a FibroScan score. I'd have another scan done with an overnight fast and if the score was similar to your first scan a biopsy would be advisable to determine the true state of your liver. If your platelet count is low a biopsy might have to wait because of the risk of excessive bleeding. For your sake I hope that the FibroScan score was a mistake.
Hi there, I had a fibro score of 75 plus i gave up alcohol and totally changed my diet, 8months later my score was 40 and i expectit to come down further over time. A swollen liver can take months to come down, i have been told up to 2 years before i will know my final fibro score.. If you eat before the test ( think it isthe same for drink ) it can effet the score by ten points ive been told by the consultant. Stay positive!.
Thank you so much for your replies. I will take the test again at the 6 month range as I have read 2 months in after quittimg drinking might have been to soon. It just seemed so contradictary to every other test .. ultrasound and symptomless counterpart.
You could ask for an ELF test, just a blood test which looks for fibrosis/ cirrhosis. Its considered reliable, it works by a specific algorithm of certain blood levels which provides you with a score.
In the UK this is done on the NHS, but only in specialist centres. I had one at the local Hosp and they sent the bloods to the nearest city hep unit.
Good luck, hope things will improve now you've stopped drinking. At least you will prevent it getting worse.
Best wishes
Thank you Wass71. Im def going to look into that tom. I also had a good read today and found out some intetesting things about fibroscans and transient elastography that I thought Id share for anyone down the road seeking info. According to a really well done study it would seem that those with Acute Hepatitis can get some false reads on a liver stiffness test. Basically the the tissue changes that happen in the liver as a result of necro-inflamation caused by the hepatitis can drastically change the stiffness of the liver (sometimes up to kpa results that would suggest cirrhotic and severe choleostasis) until the inflamation ceases and resolves. This has been proven by conducting multiple fibroscan tests over time on a patient with Alcoholic hepatitis and monitoring how the KPA results lowered in correlation with the liver enzymes lowering alongside it. It is therefore recommended that fibroscan tests not be conducted while Alt levels are 100 or above. This may explain why some of the folks on this site have seen drops in kpa readings o er the years on their Fibroacan results. Its possible that as opposed to the thought that a cirrhotic liver is reversing it is actually the resolving of necro inflamattion and that the liver was not cirrhotic to begin with. Just an interesting thought and possibly something we can all ask a dr when tests and diagnosis of cirrhosis seem to be not clearly conclusive.
I don't want to put a dampener on what you posted but researchers have also done successive FibroScans on people with cirrhosis with scores of 70 kPa who stopped drinking. They found that after a person with cirrhosis and a FibroScan score of 70 kPa stopped drinking his FibroScan score gradually went down to 7.7 kPa however when the liver was biopsied it was found to still be cirrhotic. That's why a biopsy is still considered the gold standard for determining the true state of a liver.
No dampening at all. For sure thats possible. The score would have came down as the inflamation there would resolve from not drinking in his case.Its probably likely his enzymes were also equally coming down too as I was saying. While you are right about the biopsy being still the gold standard it does have its share of false negatives. I think we have both presented fimdings here that clearly show faults in a fibroscan. I wasnt saying having a kpa lowering means one doesnt have underlying cirrhosis. I was just stating that clearly having a high kpa doesnt nessecarily mean one does. But no disagreement that a high kpa reading should be accompanied with a biopsy to confirm as no one test is 100 percent .
I was told having a biopsy unreliable as it only samples a tiny area of liver and dosn,t let you know about the rest of the liver!! x
The following quotes from the book 'Dr. Melissa Palmer's Guide to Hepatitis & Liver Disease' addresses your point:
"….the liver is a master of camouflage. Even people with severe liver disease and cirrhosis may have normal imaging studies. This is a key point to remember, and it bears repeating. Sonograms, CT scans, and MRIs can look totally normal at any stage of liver disease. That is why doctors have come to rely on the liver biopsy as the gold standard for evaluating liver disease."
"Because most liver diseases affect the entire organ uniformly, this tiny sample is usually representative of the entire liver and provides a complete story. It is unlikely that this specimen would look better or worse than the rest of the liver, but it can happen—though very rarely. This uncommon occurrence is known as a sampling error."
That is a very good point. I have had multiple scans but as we all know on this site the liver can be a bugger. Umward amd hopefully upward my friend
A Biopsy is considered the golden standard but it does only look at a small portion of the liver. The AST/ALT de ritis ratio doesn't apply to enzymes in range(My GI doc. stated)..Many enzymes go back to almost normal when you move the toxins that causing the inflammation but people don't have perfect labs when the liver is struggling, I see people post all the time that their labs are all normal. There are several things that are lower ..platelets/albumin/bun and GGT can go back to normal but it takes months into recovery for this to happen.
De ritis ratio still def applies even when they are in range.
What my de ritis is 1.3 with values of 18 and 14 . Now I'm panicking!
I see here where your getting confused Danubian. Your anxiety is only letting you see the parts that worry you. Your missing the fact that I was in the hospital with severe alcoholic hepatitis and almost died. elevated billirubin, low albumin, a fibroscan score of 58.9 and thst my deritis rstio lowered after the hospital. It was not 1.3:1 in the hospital. It was 3:1. A solutely everything was indicitive of liver disease. My alt ast was not even relevant with the blatently obvious symptoms I was presenting with. I was yellow, malnourished and half dead.
I have found a couple of times on this site tho sophia1980 that some people are unaware of the deritis ratio. But it does apply at anytime not just when bloods are individually out of their range
Phoenix, my ultrasound and MRI were fine and I was beginning to calm down! But now? I was told by the doc that it was OK because de ritis means nothing becuase they were in range!!!
I've been sober 10 months now and went through a long panic stage about my health and read a lot of different information about liver disease but I have to admit I'm done with it all. People said fibroscan are the best now that's questioned I read blood work is a good indication but that's not accurate now all scans could be wrong it's crazy. So basically you never know if there is a problem until symptom arrive. Im done reading people's opinions about blood ratios and scan accuracy. I'm going to trust my doctors and let them worry about results.
The people like me who have drank themselves here are lucky as we can stop the booze and help our condition that is all we can really do anyway eat healthy exercise and don't drink it's that simple. Be aware of your possible condition but don't let it run your life. All this doctor questioning and scan accuracy discussions are not helping. How do you feel if you feel good than great enjoy life now, we never know when we might get hit by a bus and all our worry will have been wasted.
Take care
Boone
Boone84 I totally understand how you feel. Its frustrating for us all. Try to understand though that the discussions in this thread are not our " opinions" as lay persons. We are discussing literature published by doctors through extensive studies at very reknowned establishments. Edwards1952 post was referring to works collected by a Dr. Melissa Palmer and mine was a passage from a study done at the National Centte of Biotechnology. Scan questioning and continous study is what progresses science and understanding. Definately take what your doctors tell you as your doctors know your situation best on an individual basis. As for the comment about " never knowing if something is wrong until symptoms arrive" is a very unfortunate truth when it comes to liver disease as many on here know most people dont discover even severe cases until symptoms arise. Also as alot of people on this forum know as well is that questioning our DRs and pushing them to look deeper into things is the type of self advocacy one sometimes needs to get a doctor to not just say "your fine" when when one really isnt. HOWEVER be true to what you said my friend and keep living and please understand that the up and downs and contradictory studies are frustrating to all of us as well. We are all in the same boat tho and all want answers and hope that things will get better and remain better.
Stay positive my friend
Btw i forgot to say Boone. We did not say that any of the tests are wrong or not accurate. We were just discussing that naturally they have margins for error. Its always about the whole clinical picture. If your off the alcohol feeling good eating well than nothing else matters more than that
I’ve never had a FibroScan or biopsy.
My doctor said why bother, we know you have cirrhosis.
Kindest and warmest regards,
Bob
I hear you Brett, alot of doctors say that but the kpa can have more significance than just determining fibrosis staging. It can also be a useful tool for monitoring pressure of the livers hepatic veins. Certain kpa ranges are associated with things like the likelyhood of variceal bleeding, as an example.
Some doctors also seem to have an attitude of " why bother? the score wont change", yet members of this site including myself have shown that fibroscan scores can reduce drastically over even short periods of time even in cirrhosis.
