Best Liver scan after Fibrascan..

[Ruggerhead]

For the past 2 years, have had a progressing NAFLD, despite changing diet, exercise, no sugars, drinks, losing weight etc etc. My bloods ie LFT's all seem well within range. I had expected my KPA score to go down over 2 years, but it seems to be going in the other direction. Consultant seems to think I am rare. Original diagnosis of NAFLD was made by fluke, I had 2 months of elevated bloods while in hospital. I was sent for a Liver ultrasound, CT and MRI as an inpatient, and all came back as perfectly normal, then they sent me for a fibrascan, and that was far from normal, a lot of fat and some stiffness, so I just thought change things and all will be well. But not so lucky, every one of my Fibrascans since, ie about every 5 months has shown an increase in KPA. So I want to try and get a better read on how stiff my liver is, so whats the next best way, is it another MRI? What about enhanced Liver function blood tests, I think they test other than just the usual LFT's. I have not had a drink in 2 years, I am not overweight, diabetic or ever contracted hepatitis. I would like to get a better read on how damaged my Liver really is, suggestions?

[MINTVCX]

Well maybe fibroscan is false positive regarding stiffness? It is hard to say. What is your CAP score? As you wrote ultrasound did not see fatty liver? It can be when fat is below 30%. There is something called lean NASH so you do not need to be overweight to have fatty liver.

Anyway I think you may indeed need some other test to check your liver fibrosis/condition. Check with your hepatologist other imaging tests like magnetic resonance elastography (MRE) or 2D shear wave elastography (SWE) or Shear wave elastography (SWE) - m/s. Maybe they can help.

You mentioned ELF. Ther is also specific blood test - Fibrotest.

But to be honest all above can simple complicate futher your diagnosis... There is always biopsy but it is risky for your health and must be a good reason to have it. So the best thing is to find good hepatologist to direct you.

[Ruggerhead in reply to MINTVCX]

Thank you for that advice, yes Cap was ranging from 280 to 335, no probs early on as KPA was 2.8 or unaffected, it kept rising and rising yet i was doing everything right, so as my hep siad rare and unusual, I am lean, non diabetic, fit, non drinker, been tested for autoimmune problems. Do have some gut issues IBS etc so I dont know if that is having an impact. Dont want a biopsy and all my bloods are normal, but still in Nash range on KPA. Im not sure how i access a MRE in Ireland, or is that just a MRI with some sort of plate.. I can get a private MRI but i had that before, with contrast I think, also a CT scan, but all done before problems.

[LeiL in reply to Ruggerhead]

How about Metabolic Syndrome. You don’t have to be a diabetic, pre diabetes, slightly high cholesterol, and slightly raised blood pressure could do it.

[Ruggerhead in reply to LeiL]

Interesting, my cholesterol seems ok, blood pressure a little high, but not huge. How do they test that.

[LeiL in reply to Ruggerhead]

It’s actually an assessment by your doctor. There are about 5-6 qualifiers and if you meet three of them it is considered metabolic syndrome. Sometimes the doc will place the patient on an anti-diabetic medication, blood pressure meds, and a statin just as a trial. Have you ever had a glucose tolerance test?

[MINTVCX in reply to Ruggerhead]

If you started with 2.8 kpa and it increased within 2 years I would say it very unusal. I think with NASH only is not possible to progress fibrosis that quick. The question about CAP on fibroscan is if it is not false positive also. But you can have still fatty liver without high BMI and abnormal cholesterol.

About NASH it cannot be determined only by fibroscan score. It can be some clue but is not enough.

Another MRI or CT scan they are not very good for detecting fibrosis. I would strongly suggest to do fibrotest or ELF because imaging tests are weird in your case... Maybe your fibroscan kpa scores indicate that indeed you have some inflammation in your liver or something is going on but this is only my guessing.

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[Corin1950]

Hi I too have fatty liver first seen in ultrasound, then had an ELF test and then a fibroscan. My scores were Cap 270 and KPA 4.1. So I was told fatty liver top end of mild but no fibrosis. I had tests to eliminate all other AH disease and Hep B and C etc. All negative. I was advised to try to lose weight and do regular exercise and to only have an occasional drink. My diet was already good and I’m not very overweight BMI 28 and I do regular walking. I only drank in moderation. Since then I’ve followed his advice and lost a few pounds cutting back salt and sugar and no alcohol. The specialist I saw also said sometimes you get fatty liver when you’re doing the right things because of how your body processes fat and I wondered if this might be true for myself but could also explain your results. I don’t know much about this other than what he said but maybe an avenue to explore.Hope you get some answers.

[Ruggerhead in reply to Corin1950]

Thanks Corin, that sounds about right, my BMI is similar, I take no drink etc for nearly 2 years, my diet is clean and I exercise. Did you ELF's reveal anything. Again the odd thing is that I had a CT, MRI, and ultrasound in the hospital and all came back clear, but then again they were looking at gut issues, but stil1. Liver and pancreas all fine. I have had 4 fibroscans in 2 years each with different scores. So i was trying to work out the next best test. Some here say get some ELF tests, others some other test, some say and MRE, which is more specific. Just want to know more than just be told go away and come back in a few months, its what we are often told. Oh well yes your liver is getting worse, give you a pamplet and see you in 3 months. Great,

[Corin1950]

I had the ELF test after the ultrasound showed fatty liver because I asked to have it investigated as I wanted to know how bad it was so I could treat it. The ELF test showed the possibility of fibrosis that’s why I then had the fibroscan. The fibroscan showed no fibrosis but significant fatty liver. This wasn’t considered an issue because of my age 71 and I was told I could prevent it worsening or even reduce it by diet and exercise though the specialist did say it could be a fat processing problem that some people have. He said I didn’t need any treatment as he knew I’d do my best to sort it and just said to have another fibroscan in a years time. This will presumably show whether what I’m now doing is being effective. Let’s hope it is.

[Ruggerhead in reply to Corin1950]

Ok thanks Corin, I guess given that fatty Liver seems to affect almost 1 in 3 people that you may have a mild case which it seems you do, both my Cap score and my KPA are significantly higher. My problem is, that my bloods were ok, apart from two months when I was in the hospital and they went up, so while in there checking for various cancers they gave my a CT/ MRI with contrast and liver ultrasound, all came back as clear. And bloods were normal again. So as one last test gave me a fibroscan and suddenly a very high Cap score 335, but low enough KPA ie 2.6, so told to go away and eliminate things which I have done, but the KPA keeps getting worse, and they cant tell me why to be honest..So was just trying to check it via another means, my normal bloods are fine, as are my other levels etc, but i was wondering if other tests or maybe an MRE was an option, which i believe is a more senstive test than the MRI, uses some vibration plate. Just not sure where I can get that done if at all here in Ireland.

[Onesmallstep1969]

Hi Ruggerhead. It does seem puzzling, especially since you're doing all the right things. But when you say your scores are getting worse, what exactly do you mean? The first kpa was 2.6, which is really good. What were the next several scores?

[Ruggerhead]

Has risen steadily I’m afraid every few months. Now over 8. Don’t know what’s happening.