Conflicting test results

[Sickliver]

I’m new here. I have a question I hope someone can answer. Two CT scans that I had done for other reasons s showed a mildly nodular liver. My gastroenterologist ran a lot of bloodwork including a Fibrosure test for NASH since I’m not a drinker. It came back showing NASH and cirrhosis. I immediately made an appointment with the Duke Liver clinic to see a hepatologist. Saw her last week and she ran a CT scan specifically mentioning on the request the concern for fatty liver and cirrhosis. I can’t have a Fibroscan or MRI because I have a implanted defibrillator, pacemaker and artificial mitral valve. It is against Duke’s protocol to do the Fibroscan under these conditions as well as the MRI. The CT scan came back showing no evidence of steatosis but there is cirrhosis due to Right sided heart failure which I do have. It’s called cardiac cirrhosis or congestive hepatopathy. I was wondering about the disconnect between these two tests. I noticed on Labcorp’s website that I was supposed to fast for at least eight hours before the test. I didn’t since I wasn’t told to and the Lab didn’t ask before doing the test. Can this have caused inaccurate test results on the Fibrosure test? Also, if I had enough fatty liver to cause cirrhosis, wouldn’t that have shown up on a CT scan that is specifically looking for it? Thanks for any help. And like I said, the CT scan results did show evidence of the right sided heart failure causing the cirrhosis.

[Chefpat]

I don’t know about your results specifically but I had conflicting results with my Fibroscan too. The results showed severe fibrosis and some cirrhosis but then a biopsy showed different results, less severe. Apparently fibroscans aren’t the most accurate representation of what is going on.

[nash2 Partner]

Well, the thing to keep in mind is there are no perfect tests. The only one that works without significant error is autopsy so there's that. Blood tests can vary quickly depending on diet so the standard practice is to fast. Fibrosure has a decent probability range but in the end it is a prediction. CT scans provide a different kind of information and show general structure well but struggle to define things like fatty liver or NASH. As the disease begins to cause distortion of the shape of the organ it becomes more clear so it depends on where you are in the course of the disease. Because of all the confounding variables it is is hard to get a complete picture if you can't do the more liver specific tests like Fibroscan and MRE. That said, the best evidence is the nodular liver. Actual fat content is a challenge to measure with CT but a properly done Fibrosure would probably give you a somewhat clearer picture. Since I'm not a doctor these are just musing and what really matters is your history and other medical data so talk to your doctor about it.