2D-SWE, influence of inflammation and alcohol?

[Cornwall33]

Hello everyone.

It is known that Fibroscan can offer false positive results in the presence of ongoing inflammation or active alcohol consumption, among other factors. But I haven't been able to find studies to support this for 2D-SWE.

I had a 2D-SWE months ago that returned 7.5 kPa (F2 compatible in mixed etiology). I had had COVID a month and a half before. Later, and as a side effect, I had sinusitis and took antibiotics. My GGT was around 400 IU/l and the AST was over 70. I also had a high alcohol consumption at that time (even on the same day of the test about 6 hours before I had a few beers). Serology showed cytomegalovirus and Epstein-Barr antibodies (I suspect I had mononucleosis about 4 months before)

After the results, I decided to lead a healthier lifestyle, I didn't drink anything and I ate better, with a lot of exercise. A month and a half later I had a Fibroscan which showed a score of 4.6 kPa . They did it with an XL probe (supposedly automatic probe selection tool APS, but I did not understand this choice since I am a thin person) so it is likely that the extrapolated result was around 5.7-5.8 kPa in M probe ( the results in the XL probe are usually 80% of those obtained in the M probe). This means, the results of a healthy-liver person.

According to the first test, 2D-SWE was in F2 (maybe still F1 in alcohol etiology) and the result from the Fibroscan clearly stated that it was "F0 and without signs of liver fat" (bloods had completely returned to normal, even GGT was 50 UL/l)

I still think (too much) about whether Fibroscan could underestimate fibrosis, since in several medical papers it seems to say that inflammation and alcohol consumption do not affect the 2D-SWE test, although not conclusively. And it seems like a very short time for that drop in liver stiffness. Do inflammation, AST and GGT levels influence the results of 2D-SWE test?

What do you think about it? Greetings.

[MINTVCX]

1. Fibroscan or 2D-SWE can be both false positive or false negative regardless of liver inflammation. Although it is one of known factor that can lead to false positive for sure for Fibroscan (about 2D-SWE maybe not).

2. As I know the lowest possible value for fibrosis is F0/F1 for typical liver damage factor.

3. Fibroscan is better to rule out severe fibrosis than confirm it.

[Confused-one]

You sound very well researched and have brought up facts I didn't know like the divergence of results between an XP and M probe (I'm a little sceptical about this as an absolute: it sounds more like a scope of divergence of result than a fact. If it were the latter, results would come with a warning to this effect). As you know the results are the median of multiple readings during the test, so while false negatives and positives exist, you have two median scores of probably at least 20 readings on two different occasions, which amount to a low issue and not-an-issue, so to a certain extent, what are you worrying about?

I do understand your position of doubt though - having received a decompensated cirrhosis diagnosis in 2020 with disastrous bloods and a liver scan showing a coarse ecotexture. However it followed a severe bout of covid and the decompensated became compensated quickly. I was given a fibroscan in 2022 which showed a result of 6.7kpa. My consultant said he essentially didn't believe the results and sent me for another. The heptology nurse, a little irked at the doubting of the scores did twice the readings required and I got a mean of 7.4.

Now, that's not great, but at 30 plus readings I see no reason to doubt those results and it puts a different spin potentially on where I am. I am waiting to see my consultant and see what he thinks. Cirrhosis is typically clinically diagnosed at 16kpa f4. I helped run a covid support group for 2 years and we have a small but notable group of people who had severe covid with alpha and delta who got serious but mostly temporary organ damage to kidneys, liver, and heart. This was often really pretty bad but for many turned around in 6 months which is what happened to me.

I have begun to wonder if the severe covid had also inflamed my liver into a temporary failing state for the original diagnosis and whether this explains an over-statement of what is nevertheless a low f2 reading. Tbh, I think that for my consultant, dealing with many serious cases, I'm basically off the radar at the moment but I wish someone could also give me some thoughts on what might be happening here. I have a coarse ecotexture in scans (no other detail). I've never seen the scans and the fibrosis is low yet I am still in diagnosis of cirrhosis. I wish I knew what was really going on and if anyone has any thoughts on this including you OP, I would also welcome them.