Ultrasound with elastography

[JohnJ1978]

Hi Everyone,

I am a 42 year old male living in the state of Maine. I went to the hospital in early December for severe mid-right back pain and a CT scan came back showing what the ER doctor called “severe” hepatosteatosis. The same scan showed a nodule in my right lung (nicer word for tumor) which came back benign on a PET scan but is being followed by CT scan for changes (first one this morning - wish me luck!) but that is for a different forum. They think the pain could have been due to either/or. My Gastroenerologist has since told me that a CT scan can’t show severity of fat accumulation, but my primary was concerned because a CT scan in 2018 showed no obvious fat accumulation. A blood test during the same ER visit showed ALT 74 and AST 42. A follow up blood test at the end of December showed slightly lower numbers of ALT 70 AST 35. Historical blood tests showed mildly elevated enzymes going back to at least 2018. After lots of online research - including this wonderful site - I decided to pretty drastically change my lifestyle and stopped drinking, cut out all bad fats and simple carbs, added liver healthy options whenever possible and started taking a brisk daily one mile walk and doing about an hour of resistance band training about 4 times a week peppered with some exercise bike cardio and now trying to work on some HIIT training (intense!). The pain/feeling of pressure in my side/back slowly subsided over the course of a couple of weeks. As of today I have lost around 13 pounds. On January 25 my blood test showed ALT 29 and AST 21. My long elevated blood pressure has resolved itself, which is great. The gastroenterologist said the fat accumulation and elevated enzymes were most likely due to my daily beer drinking - 2-3 strong beers daily - since I was not very overweight. But I have read all kinds of things online saying if it was due to drinking my AST would be the higher number etc. I was also very sedentary with little to no exercise for many years (especially true while I have been working at home for the past year due to Covid) and did not have a very good diet at all - vegetarian with lots of bread, pasta, and cheese.

Any input about anything here?

One specific question I have is this - I am scheduled for an ultrasound with elastogrophy on March 10. Is this the same thing as the fibroscan I hear so much about?

Thanks so much to everyone on here. It is a blessing the way you all share the information you have with those who need it and an inspiration the way you share your courage and honesty. And keep your chins up!

[nash2 Partner]

Hi John

Sounds like you are doing all the right things and it is paying off for you. CT and Ultrasound are good for structure but neither is very good for fat or measuring scarring. The US with elastography is a fairly new tool which is similar in concept to the FibroScan and is a big improvement over standard ultrasound. It is measuring liver stiffness using sound waves compared to Fibroscan which uses a mechanical thumper. None of the tests are perfect but this will give you a much better sense of your liver health. With the lifestyle changes your liver health will have improved. Alcohol will never be your friend but it sounds like you have a good sense of where you are going so congratulations.

[JohnJ1978 in reply to nash2]

Thanks so much for the response and for all you do. This site and the fatty liver foundation website have been extremely helpful!

[Alterity]

I have many nodules on my liver. They check them every 6 months just to make sure they are not growing or changing. I've not had any changes in 20 years. My blood work goes up and down and is so unpredictable. I was in stage 4 fibrosis and down to a 2/3. I too lost 40/50 pounds. I have cirrhosis, the elasticity test is to see how hard/stiff your liver is. Sounds like your doing the right thing. No red meats and No alcohol .

[JohnJ1978 in reply to Alterity]

Thanks for the reply. All we can do is do our best I guess and time will tell. It is great that all of the things that are healthy for our liver seem to be healthy for the rest of us as well.

[Kettl in reply to Alterity]

Do you mind me asking what your elastography kpa was?

[JohnJ1978 in reply to Kettl]

Hi Kerri. Can’t tell if you were asking me or Alterity but my ultrasound showed a 7.4kPa. My gastroenterologist said this was good news even though technically it shows mild fibrosis.

[Kettl in reply to JohnJ1978]

Thanks yes. My ultrasound elastography is 7.8kpa didn’t know where I stood or if it was different from fibroscan people have. Thanks

[TNWONDER]

I had an US with elastography done a couple of months ago......As Nash2 explains below its similar in concept with one big exception in my experience.....while they measure your liver stiffness and calculate a corresponding Kpa score, they don't measure the level of liver fat (ie. CAP score). I was a bit disappointed given that i know that i have a fatty liver and would have liked to know where i scored. The good news was that my Kpa was normal 4.2 for stiffness so im a F0. Lastly, it also comes down to how experienced the tech is who is administering the elastography. Luckily the tech that i had trains others on how to use the machine. Good luck.