Fibroscan CAP scores

[mickeymouse42]

There are a few things that I don’t understand about Fibroscan CAP scores.

I have looked at the NICE 49 full guideline which can be found here:

nice.org.uk/guidance/ng49/e...

Fibroscan CAP scores are discussed in detail on pages 62 to 74; the CAP scores summary is based on 5 studies. This colour coded chart from an organisation providing Fibroscans in the UK appears to contain similar CAP ranges to what is discussed in the NICE guidelines:

tawazunhealth.com/fibroscan...

There are a few things that I do not fully understand.

A Fibroscanner appears to calculate values between 100 db/M (decibels per meter) and 400 db/M. As far as I can tell this range refers to the sonic range of the equipment rather than to a reference range that for example is quoted in blood test results; for example the local pathology gives a reference range for B12 as being between 197 ng/L and 711 ng/L.

A normal healthy liver is said to have < 5% fat. If you did a set of Fibroscan tests on a cohort of young healthy children, would you expect their CAP score to be around 100?

The steatosis grade S0 which is colour coded as green has a range of 150 - 248 db/M indicating < 10% fat. Why does the range start at 150 rather than 100? Why is the range so large in comparison with the S1 and S2 ranges?

The steatosis grades S1, S2 and S3 are respectively 248 - 260, 260 - 280 and > 280 which correspond to far ranges of 11% - 33%, 34% - 66% and > 67%. The S1 and S2 bands are tiny ranges.

The liver is a large organ and I'm not sure that the scanner can scan the whole liver? I suspect that someone who has a CAP score of 247 could easily be rescanned and have a score of 261 which could mean that nearly 50% of the liver is fatty.

Are there many people here who have a CAP score over 280?

I got my diagnosis of NALFD from a small bowel MRI scan which states that I have "generalised hepatic steatosis". I've also got too much fat in my pancreas (from a gallbladder/pancreas MRI). I've severe BAM (Bile Acid Malabsorption); people with BAM invariably have NAFLD. It's a pity that MRI scanners cannot estimate fat levels.

[sophiaS1980]

MRE can do that

[mickeymouse42 in reply to sophiaS1980]

What fat percentage did you get?

[Pinkglitter93]

I had my Fibroscan on the NHS which showed a CAP score of over 300 and KPA 13.6 so very worrying. My MRI was normal. I’ve now seen a private consultant and he said the Fibroscan is dependent on the operator. In the NHS they only take 5 readings and take it from that. He’s going to repeat it and do about 30 readings and get the best measure.

[mickeymouse42 in reply to Pinkglitter93]

Thanks for the reply. My CAP score was 255 which appears to mean that my liver has between 11 and 33% of excess fat. I'm going to ask my GP for a new lipid test and a serum lipase test as the MRI scan showed an atrophied pancreas. Do you have a recent lipid result? It would be interesting to know how a lipid result correlates to a CAP score of over 300. Have you ever had a lipase test?

[Pinkglitter93 in reply to mickeymouse42]

I haven’t had a lipid test that I am aware of.

[mickeymouse42 in reply to Pinkglitter93]

If you get the NHS app, it will connect to your GP's system after they have enabled the feed and you can see the history of all your blood test results. It's a game changer as I can now reason about my health without having to wait on the phone for half an hour to ask a receptionist for the results.

[Pinkglitter93]

I have the NHS app. I have just checked and last lipid test normal. I’ve been to hospital over weekend with another issues and bloods normal (apart from raised inflammation levels).

[mickeymouse42 in reply to Pinkglitter93]

I’m not sure that Lipid tests include the serum lipase test which i think is looking at whether the pancreas is releasing enough lipase to break down fats. I have high triglycerides and it’s not because I eat deep fried mars bars every night. I follow the portfolio diet designed by Professor David Jenkins of Toronto University which would be better named as the lipid diet; it is the diet described in the BHF’s literature. If you have low lipase levels because of a problem with the pancreas, high triglyceride levels and high CAP scores are inevitable.

[BritishLiverTrust8 Moderator British Liver Trust]

Dear mickeymouse42

If you 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)

Best wishes

British Liver Trust