Over two years ago, I was diagnosed with alcoholic hepatitis and fatty liver. I’ve had four ultrasounds and an MRI since then which showed progressive improvement and my last ultrasound in July and the MRI last September showed normal ecotexture, smooth texture, and nothing at all wrong with my liver anymore. I do have gallstones. Everything is within range on my LFTs though the bilirubin fluctuates because I have Gilbert’s Disease. So onto my question:
Through all of this, I have never had a fibroscan. I have read a lot on here about people having fibrosis diagnosed through fibroscan despite the liver looking fine on ultrasound and LFTs being fine. I’m afraid that even though everything has improved so much with my liver and it appears to be healthy now, I may have scarring that wasn’t seen on the ultrasounds/MRI due to the past liver inflammation. Do those tests not show scarring if it is present? The specialist isn’t even concerned about my liver anymore at all but is more interested in convincing me to have my gallbladder removed because of gallstones though I’ve never had an attack. Should I push to have a fibroscan or just accept that they didn’t seem to believe I needed one?
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SerenityFirefly
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If your MRI is clear and numerous ultrasounds clear too then there seems no point doing a fibroscan - fibroscan alone can never be wholly accurate and any result would need to be looked at in conjunction with all other tests and scans you've had.
If a highly qualified specialist is no longer concerned then really neither should you be. I take it you underwent some positive lifestyle changes after uou hepatitis diagnosis and by halting the attack on the liver have cured the inflammation and reversed the earlier damage.
In your opinion would the MRI and US be accurate in detecting fatty liver? I have seen numerous posts on here which say these tests have missed fatty liver only for it to be picked up on fibroscan?
I hope all is well with you and hubby is recovering!
push for a fibroscan before removing gall bladder would be my take on this. I had what looked like a perfect liver on hospital mri and ultrasound, bloods good. But on fibroscan some real scarring.
I suppose part of the decision to push for a fibroscan or not would be to consider what you would then do with the information. If there is medication or other treatment protocols available for liver scarring (I don't know if there is) then there is an obvious reason to scan. If you are going to adjust your lifestyle on the basis of the scan results then there is another obvious reason to scan. If, however, you are already looking after your liver well (which would appear to be the case given your excellent progress) and do not intend to stop doing so then would a fibroscan result be of much use?
I think you've summed up the issue for quite a few people. I am in the situation whereby a fibroscan is showing F4 but nothing else is. From my understanding (not a clinician) a fibroscan seems to check the elasticity in the liver so is pretty good for assessing fibrosis however it is prone to inaccuracy if you are obese or have an inflamed liver. Ultrasound is primarily there to check for lesions and is very good at detecting late grade cirrhosis but not so effective at judging fibrosis levels where that isn't the case. Blood tests look at liver function but, with many stages of compensated liver disease, this can be normal. The only two I haven't had are an MRI and a biopsy. An MRI sounds helpful (particularly together if it's with an MRE so am considering trying to get this privately) in assessing fibrosis, but even that isn’t perfect either. The gold standard for fibrosis remains biopsy. The problem with the biopsy is it is invasive and no-one is too keen on them unless the clinical need for certainty around staging will provide a better outcome…..and here comes the rub…..
As the treatment for everything between F1 and F4 for the majority seems to be the same lifestyle changes, once it is clear you have some form of liver damage, there is little physically to be gained by a nailed on diagnosis. You either make the changes or not and, if things get worse, it will eventually show in one of the other screening tests.
The problem is the mental health element of not actually knowing if you have a cirrhotic liver or not and this is what I am struggling with currently.
I completely understand the mental element. It is also nice to have a way of objectively measuring the results of any lifestyle changes and, as you say, things like blood tests aren't all that useful. Although I have seen some reference to the ELF blood test being useful for staging and monitoring fibrosis. Maybe that would be something to look into?
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Ultrasound question about coarse texture
Mild Scarring
Cirrhosis with clear Ultrasound and bloods? 
ultrasound 
