How Accurate is a Fibroscan

[Hanc]

Hi all hope you are all good, just like my question says I have read various posts etc on the accuracy of fibroscan readings, with some saying they are accurate and others saying they are not. If taken alongside good blood work and other good imaging results can the accuracy be more trusted. I am not asking for medical advice etc just people's opinions and experiences. Thanks for any input into this discussion.

[GrandmaDylan]

I finally saw my liver specialist last week who is testing for AIH as I don't drink but have been diagnosed with cirrhosis. I will have a liver biopsy if the blood results show negative for AIH. I asked if I would have a fibroscan but he said as I already had a firm diagnosis of cirrhosis it would be pointless. Have you been diagnosed with cirrhosis or fatty liver? Deb

[Julie8]

I think it’s about how successful the scan was. Mine last Jan was 75% successful and showed a score of 21, so it could be that the 25% is working well. Either way it’s serious and I have to follow no alcohol and healthy diet.

[Garyvh]

Hi,

All I know is that my liver has 'an echo genic texture suggestive of cirrhosis', according to my ultrasound results.

Whether knowing more than that would be of any benefit to me, I'm still undecided...

I had/have all the classic symptoms of cirrhosis, but how much of that is muddled up with Alcoholic Hepatitis I don't know.

By accounts on this forum though, it appears that fibroscan results obtained during active hepatitis are less than reliable in accurately showing the severity of any underlying cirrhosis.

G

[Hidden in reply to Garyvh]

Perfectly put Gary

[Hidden]

Hey Hanc. I have posted quite a bit on fibroscans. In short fibroscans are incredibly reliable at measuring what they are designed to measure which is liver stiffness. They don not read fibrosis or pick it up. They claim to use liver stiffness to correlate an estimation of how much scarring or fibrosis a person with that liver stiffness would have. Now heres the downfall of them. Whilst they do pretty accurately at reading liver stiffness, they fail to differentiate why a person's liver is stiff. As an example if the liver is inflammed currently the inflammation while cause the liver to swell this giving the fibroscan a higher ( sometimes way higher) result. This has led people to be diagnosed with severe fibrosis or even cirrhosis when in fact they dont. On the other side of the coin people who do have cirrhosis that is in an inactive state meaning they have no inflammation currently have seen their liver stiffness drop and become soft again. This obviously gives the fibroscan a much lower result. This has led to people being told they dont have cirrhosis when in fact they do.

So heres the short answer. Fibroscans are merely a tool used for a doctor to better see the big picture and the big picture must include other testing in combination to properly diagnose a person. Any doctor who diagnosis a person solely based on a fibroscan ( and it happens alot) should be put in front of a medical review board. Also a fibroscan should never be interpreted by ANY doctor that isnt a qualified hepotologist as they know the issues with fibrscans that I have mentioned here. In fact the creators of fibroscans are themselves starting to really a knowledge this problem In misdiagnosing. As an example my fibroscans score was 58.9 when I went in the hospital with alcholic hepatitis. The score after 2.5 months of not drinking was down to 38 and that was in may so we will see what it is comes December when I get tested again.

Hope that helps brother!

[NomoreVodka in reply to Hidden]

I have my doubts about the accuracy of the test. Im right out of Hos. Because of alcohol and my ammonia levels so high I was comatose and blood work was terrible. My 1st fibro scran was high around 60 and the Doc was talking transplant. And now 6mths later my blood work was perfect. No Alcohol and I asked her does a person with perfect blood work all within range need a transplant? She says no not usually. We need to do that test again. Now my fibroscan is 26. I don't think that this test is reliable. It puts people in a panic mode. This is my second liver doctor. My first doctor said the only way to tell if you have cirrhosis is with the scope. Going down your throat. And actually looking. And I'm a female in my 40s to young to be having these problems. I've been in the hospital 5 times for this. I do like my wine. And beer. But it can get a little expensive. So then I'll go to vodka. What's weird to me. It's seems like every time I go to vodka. Within two months I'm in the hospital. And I'm not drinking that much. I am only 100lbs but I was drinking about 3 to 4 drinks a day. Or 3 glasses of wine. But when I switch to that vodka it puts me in the Hospital. Its like my ammonia levels slowly climb with the vodka. But not wine or beer. ?? But I'm not drinking anything now. Its not worth it.

[Hanc]

Thank your all for your kind replies, and I would agree with you phoniexpalazzo, that it needs to be done in conjunction with other tests to get the full picture. Mine was done by a Hepatologist after blood tests showed no inflamation and an ultrasound showed mild fatty liver and the result was 4.5 Kpa CAP 120 showing little to no fat, so I was just wondering how accurate this reading is. The Hepatologist said no fibrosis and had all the access to the other test results. Hope your next test is good Phoniexpalazzo.

[Hidden]

For the fibroscan to be useful it has to be known what type of hepatitis is occurring as the scale for alcoholic hepatitis is different to the one for NAFLD and different again for other causes of hepatitis.

Secondly, the scan is done by taking an average of 10 readings. These readings could occur across a section of the liver relatively undamaged and give a low average score. Alternatively, they could be taken across an area that is very damaged and give a high average score. However, neither of them gives an "accurate" picture. The next time the scan is done at a later date, the 10 readings could come from a different area of the liver from the first time and give a different reading again. This is one reason why people can receive different readings, even when nothing has changed. There are other reasons, but for my type of hepatitis (AIH), we have been told that little emphasis will be placed on the fibroscan scores since there are many reasons at the moment that it is only an additional tool, not a tool for diagnosis.

For clarity, I have a very low score on the fibroscan, but my disease has progressed to bleeding varices, which the low score would not indicate.

The machine takes accurate readings, BUT the use of readings is limited from what I can see because of all the other factors that must be considered. This means that whilst the readings are accurate, the conclusions that are drawn from it may not be. Hope you followed this

[Hidden in reply to Hidden]

Good post! You and I seem to both be great examples of how the fibroscan can be interpreted incorrectly. Whilst your score would have a doctor believe nothing is wrong in fact you know other wise. My score was extremely high due to the alcoholic hep but have no signs of fibrosis on any test done so far to find it.

[Hanc in reply to Hidden]

What other tests did you have done that showed no fibrosis PhoenixPalazzo, if you don't mind me asking?

[Hidden in reply to Hanc]

Ultrasounds and ct scans

[Hanc in reply to Hidden]

Thanks Phoenix, much appreciated.

[Hidden in reply to Hidden]

Cheers for that Phoenix, always good to know that a post has been useful.

[Hidden in reply to Hidden]

Thank you as well MC1189 , now if we can just get a cure for this damn liver disease we all could never have to care what a fibroscan means anyways 😊

[Hidden in reply to Hidden]

Haha! Amen to that !

[Hanc]

Thanks for the kind reply and yes it does make sense. Mine was for heavy drinking. In all I have had five fibroscan tests dating back from 2011 all done in different places by different operators, the last one being a Hepatologist, and none have been over 5.6 Kpa (in fact the time of the 5.6 Kpa I had been drinking quite heavily right up to the Fibroscan, so I don't know what this means), all have been done in conjunction with other tests (Blood Work, Ultrasound) and I presume from different areas of the liver depending on the operator, so I am wondering if this tells me I have no scarring or not? The Hepatologist said none, but now I am very worried as I don't know. I found this webinar that I think explains things clearly from two German Hepatologists (in English). At the 35 minute mark it explains two case studies of heavy drinkers using the Fibroscan and other markers to assess liver damage. The whole webinar is quite interesting.

youtu.be/-I-1fJYnMpA(Not working as expected?)

[Hidden]

The fact that you have had so many fibroscans done in different places would suggest a consistency at least in the readings and therefore the conclusions that the doctors are coming to for you. My damage must be around the portal vein area for my illness to have progressed to varices. My fibroscan reading would suggest that the rest of my liver is good and my LFT's suggest that my liver is functioning as well as can be expected in the circumstances. However, where my damage is, is causing the problem. Since you are getting many readings all very similar, performed by different operators, it would seem reasonable to conclude that much of your liver is undamaged as yet, but if you are really worried about this, then it is best to quiz your doctor as they have the bigger picture to hand. I can only comment on how the fibroscan works and the limitations in interpreting it. All the very best

Tried to play the webinar, but it wouldn't load. No need to try to fix it on my behalf though, just for info.

[Hanc in reply to Hidden]

Thanks MC1189. Will try to fix the link.

[Hanc in reply to Hanc]

That should be the link fixed now.

[Hidden]

Agreed again . The consistent readings are a good thing here. If the big picture is pointing to you not having ALD then breathe a sigh of relief. Just try to keep the drinking within reason and you should get on just fine. As I stated before liver disease due to alcohol o ly happens in a small percentage of heavy drinkers. You may be one of the lucky ones that dont get affected by it as far as li er is concerned. But just keep in mind not to beat up on the other organs involved either as they are not as forgiving as the liver can be.

[Hanc in reply to Hidden]

Thanks brother again much appreciated.