Hi everyone I just joined and was hoping for some opinions whilst I wait for my next appointment. I used to HCV which was treated successfully around 8 years ago . My fibroscan result before treatment was 22.9 and was told I have Cirrhosis . After around 2 years of being svr, cured my next fibroscan decreased to 8.1 . I had another fibroscan last year and it was 6.8 and I was told I was in now around the normal range. I was very happy until recently I had a ultrasound elastography and was told my score was 18 and I am cirrhotic. I was startled and did not ask the questions I should of . I have another appointment in the next 2 to 3 months but I am not sure what to believe. I am concerned. Either both fibrocans were wrong or I have gotten much worse in less then a year. I live a very liver friendly lifestyle and my alt is about 39 so not inflamed and I am hoping the elastography was wrong. Any thoughts ? Thank you.
Fibroscan vs Ultrasound elastography c... - British Liver Trust
Fibroscan vs Ultrasound elastography completely different results
Dear searelax
If you [are in the UK and] would find it useful to talk things over, our nurse-led helpline is open Monday to Friday from 9am to 3pm on 0800 652 7330 (excluding bank holidays).
Test results vary according to both the individual’s whole health and the laboratory analysing the results and should always be interpreted by the user’s own health care professionals.
We suggest talking this through with your own doctor or health care professional.
Also, here is a link to some information on our website about preparing for future appointments, including questions to ask your doctor, which you may find helpful:
britishlivertrust.org.uk/in...
Best wishes,
British Liver Trust
hi, I’m so sorry you are going through this, talk about emotions up and down, I’m sorry I can’t help as I’m totally confused with the whole liver thing myself, but I just wanted to say that I can understand how confused you must be feeling and wanted to send you a big hug xx
the liver stiffens up after eating
i decided to not eat for 12 hours rather than the suggested 8 hours to help my kpa to be more accurate
I would go the biopsy route or exploratory surgery to actually see the liver. These scans are very user dependent which makes them skewed as the results. I stick to one scan at the same place every other year.
Hi. If you have already been diagnosed with liver cirrhosis, assessing liver stiffness with a fibroscan or elastography has no practical value. Cirrhosis is cirrhosis. There may be potential errors by the operator during the examination. Indeed, in some cases, partially reversibility of cirrhosis is possible upon elimination of the etiological factor (such as alcohol or a virus) to incomplete septal cirrhosis. In incomplete septal cirrhosis, the septa appear as thin, incomplete partitions, and a special histological staining for reticulin fibers is required to detect them. In incomplete septal cirrhosis, the liver stiffness measured by fibroscan will be below the cutoff point for cirrhosis (F3, 2, 1, or even F0). However, this can be considered a false-negative assessment. Even with incomplete septal cirrhosis, it still remains cirrhosis. Although your elastography result most likely points to an operator-related error on previous Fibroscans.
hi Fibro,
In this incomplete septal cirrhosis, what risk factors still remain, meaning for decompensation or such? Is it still detectable by ultrasound, ct scan or mri?
What does it mean in regards to prognosis ? I’m just curious.
Thanks.
With incomplete septal cirrhosis, all risk factors characteristic of liver cirrhosis are preserved and decompensation of liver function is also possible, which looks paradoxical. Although the histological structure of the liver visually improves, however, vascular changes characteristic of liver cirrhosis do not undergo significant improvements. An experienced pathologist can see these vascular changes. Therefore, portal hypertension persists. Visualization of ISC on CT, MRI and ultrasound will be difficult. With visible signs of portal hypertension, non-cirrhotic portal hypertension may be misdiagnosed, although a history of cirrhosis virtually rules out misinterpretation. However, there are not so many observations of the natural course of incomplete septal cirrhosis.
Hi Fibro, so are you saying that portal hypertension caused by incomplete septal cirrhosis could be mistaken as of different origin, other than cirrhosis somewhat reversed?
Does portal hypertension always exist with cirrhosis?
If fibrosis/scarring lessens would the portal hypertension decrease somewhat?
If the body creates its own shunts or collaterals and adapts to it, can it function as is ?
Thanks
Hi Greengal. Thanks for your question. The problem is that the blood flowing through the shunts is not cleared in the liver of intestinal toxins and ammonia, which eventually leads to the development of hepatic encephalopathy up to hepatic coma or causing Alzheimer's disease type II. I think that portal hypertension of varying degrees always accompanies cirrhosis of the liver. It all depends on what criteria we will choose to diagnose this condition. The choice of criteria is always subjective. Only direct measurement of the pressure gradient in the portal vein can serve as a reliable criterion for the diagnosis of portal hypertension, but this study is rarely performed due to the invasiveness and potential danger. Should be written also the progression of vascular liver diseases with non-cirrhotic portal hypertension can lead to incomplete septal cirrhosis. That is, incomplete septal cirrhosis may occur due to regression of complete cirrhosis, but also occurs due to the progression of vascular liver disease. Definitely ISC an enigmatic disease.
Thank you Fibro. Definitely a lot of detailed information to wrap one’s head around.
I’ve read that sometimes it is dependent on what part of the liver the fibrosis/scarring occurs. Can this affect the degree or reversibility of fibrosis on portal hypertension? Is it typically uniform or concentrated throughout ?
If the portal hypertension decreased due to decrease in inflammation, scarring and medication (beta blockers) have there been cases in which earlier formed collaterals or shunts reduce flow or dry up like an unused tributary to a river ? I was just wondering
Would degree of detrimental effect of these (as you mentioned above) vary based on the location or nature of it?
For a spleen which is high end of normal size. Does that or can it change significantly ? If the size remains the same would one somewhat assume that the portal hypertension is under control ? Can the spleen reduce in size?
Thank you so much
Indeed, if liver function improves and fibrosis and inflammation decrease, then anatomical and functional shunts decrease too, including after successful liver transplantation. Probably this may be due to the receipt of compensation after decompensation. Most likely, this process is partial and mosaic in the liver and its individual sections may have different histological visualization. However, the reverse development of histological changes, especially concomitant vascular changes, does not occur in full.With regard to the size of the spleen, it can indeed may return to normal size after enlargement if portal pressure decreases as a result of improved liver function or the formation of new shunts and collaterals, which also partially reduces portal pressure or after the TIPS procedure for example. It is also possible that with a slow increase in portal hypertension and a simultaneous increase in blood shunts and collaterals, the size of the spleen will not change significantly.
thanks so much Fibro!
For cases which are compensated and not as severe, are there any medications being explored to help improve liver function? Help reverse it to the maximum capacity?
I’ve read about statins, curcumin, etc? And then you have the whole platelet issue, which while the anti-inflammatory meds can help, they also can decrease platelets. It’s another paradox. Is there anything similar being explored for use specific to portal hypertension (since these were made to address traditional high blood pressure and heart disease)?
Thank you!
I probably read the same sources as you, dear Greengal, maybe a little more in relation to my own situation 🙂
Hi Fibro, my apologies for being so daft as not to check out your situation. No wonder you are so knowledgeable in regards to non cirrhotic portal hypertension. 🙃
I’ll read more and comment soon, once I have time to take in all of the details. I just got back from a big celebration for one of my kids who just graduated from college! Yey!
Thank you!
Appreciate all the replies very much. My ultra sound in january looked good just a slightly a fatty liver so I am puzzled. As this ultrasound elastography was totally different, I was surprised they wanted me to start taking Carvedilol as this has never been mentioned to me even once before. I am already on Blood Pressure medication although I know this Carvedilol is different.
hi Searelax, did the same doctor review both scans and bloodwork? Do they know you are already on blood pressure medicine ? Maybe there is a gap in shared information. ?
I went to two different hospitals basically to have 2 opinions. I had 2 fibro scans at one hospital with the first 8.1 about 4 years ago and another about 10 months ago with a fibroscan score of 6.8. I do not have an enlarged spleen or portal hypertension as far as I am aware. The recent test I had this month was at another hospital was offered as I had some offer health issues which are not related to the liver. The latest result from an ultrasound elastopgaphy was 18 and they seems eager to have me start taking Carvedilol and to perhaps have a gastroscopy where're the other hospital basically said I am looking good which was in earlier this year. I am not sure who is wrong and it is making me anxious but I guess I need to wait until my next appointment in 2 to 3 months.
Have you thought about the option of a biopsy?
They do not seem to want me to have a biopsy as I have had several ultra scans and fibroscans over the years. I just do not understand how my fibro scan result was 6.8 last year and they told it does not seem like I have cirrhosis last year and now about a year later the opposite.
Hello Searelax. There are many things that can affect the fibroscan. I never heard of the ultrasound with elastography. However I did have a mri with elastography. This test is the most accurate and shows basically everything. Unfortunately the test is not widely available. Once you have been diagnosed with cirrhosis repeat testing with a fibroscan is really unnecessary as long as you have removed/stopped whatever caused liver damage in the first place. Fibro is very knowledgeable and 100% correct. After that it’s monitoring every 6 months. Mri, bloodwork and hepatologist appt. An mri or CT scan should tell you if you have portal hypertension. I have it and hoping it will resolve in some miraculous fashion. Gastroscopy? If they have diagnosed you with cirrohis you should have had a colonocopy and endoscopy to check for varices. Honestly my gastro doc finding a few varices is what really set alarm bells off which resulted in sn appt with a hepatologist.
The liver is a crazy organ and everyones responds differently which is why I believe there’s so much mystery and confusion around cirrohis and fibrosis. will it get better, will it progress, or will it just maintain its remaining integrity.
I was diagnosed over two years ago at 38. It sucks and was shocking and it took me a while to accept it. Honestly I’m not entirely sure I have accepted it fully. There are several on here who abused alcohol including myself that will say the same thing since kicking the booze out I’ve never felt better (minus the regret of not stopping soon enough)
My biggest advice is to never drink again, eat much better than you did, remove as much salt, sugar, and processed food from your diet,(hard to do here in the states) and learn to be optimistic as much as possible. It’s quite possible to live a rather normal life as long as you follow the specialists directions. Push for a colonoscopy and endoscopy if you haven’t had one yet.
Wishing you the very best
G.
I went through almost exactly the same thing as you did. Originally diagnosed with cirrhosis after an ultrasound 10 years ago, I also had an enlarged spleen at first. I believe a Chinese so-called herbal I'd been taking for about 10 years for insomnia was the cause of what was later diagnosed as PBC with the resulting cirrhosis. As soon as I stopped taking it and started taking Ursodiol, my spleen returned to normal size. I had fibroscans twice a year, then once a year, then every two years. The scan results were better every time. I assumed mistakenly that my cirrhosis was reversing because nobody ever told me differently. I had an ultrasound twice a year and I wasn't told that I still had cirrhosis until a couple of years ago when I got a new GP and he called me with the US results. (None of my previous doctors called me with US results.) It was a bad case of lack of communication. The doctors where I used to live are pretty awful IMO.
Anyway, here it is 10 years later and I honestly feel better than ever. I have never had portal hypertension. I've always lived a pretty healthy lifestyle but I've cleaned it up even more. Apparently I have overall diffuse nodules covering my liver. I don't know much more than that. I'm going in for a scan again this month although from what I'm reading here, it's a needless procedure. My lab results have remained normal for many years. Maybe I'm just one of the lucky ones. So far, so good.
It is tough for sure and happy you are doing well, if you don't mind me asking what were your fibroscan results? I understand that fibroscans are great at determining cirhossis but not f2 or f3 . Thank you
When I was first diagnosed 10 years ago my score was 35. Two years later it was down to 14.3 and it kept dropping until five years ago it was 10.5. A year and a half ago it was up to 15.9. I have my doubts about that last result...it was a new technician and he took all of 2 minutes to do the scan. I was also told that I had NAFLD at that point however my lab results and ultrasounds have remained consistent. (My BMI is in the average range.)
I asked my gastroenterologist about why I even have scans done and he told me that they're a better test to determine cirrhosis. So that statement seems contradictory to me...if my Fibroscan scores dropped down to F2 but my ultrasounds have consistently shown cirrhosis, why would the scan be better at determining cirrhosis? I've always had a lot of questions that go unanswered or the answers don't seem clear to me.
So I've decided to just carry on living my life without worrying about it. This past year I haven't even had any fatigue issues at all while in the past I would still get a couple of days of extreme fatigue here and there, out of the blue. I feel like doctors still don't have all the answers and a lot of what happens with our health can be widely different, depending on the person involved.
They tell me the liver is a vast organ and even biopsies are not always very accurate so I guess I need to wait and see, I hear what your saying. I felt alot better prior to my recent doctors appointment now I am feeling bloated after a big meal , bit more itchy which brings back bad memories. Confused and anxious until my next appointment.
Try not to let your mind run away with you. No sense worrying about things until you know for sure. Even after seeing the doctor you may not have all the answers. My gastroenterologist admits that they're a long way from knowing everything.
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