Ultrasound scan

[Amy190]

Hi all, bit frustrated here - so tomorrow I was having my liver follow up with a new fibroscan 6 months after my first.

It was cancelled today 😞, all that anxiety to now go on until my next appt at the end of July !!

Bit of background about me : I was found to have a kpa of 20.5 and CAP of 400 on a fibroscan in December 2020 suggest of F4 fibrosis / cirrhosis

this was incidentally found and I didn’t even have raised liver bloods.

Consultant had agreed he thinks fibro results were overstimated due to my BMI but they won’t know , they wanted a biopsy - I said no and wanted to wait which they agreed to see what a second fibroscan had said.

In the interim I’ve had an ultrasound of my stomach to check for gall stones , my liver bloods are perfection with an ALT of 24.

So the report says :

Visualised section of the liver shows increased parenchymal echogenicity suggestive of diffuse fatty infiltration , any focal lesion cannot be entirely excluded

Spleen normal and not enlarged.

It was the quickest ultrasound I’ve ever had in my life , he mentioned nothing of the portal vein and when I asked if my liver was enlarged he said yes - but hasn’t reported that!

He also said if your liver had advanced cirrhosis I would see it on this scan, with early scarring it can’t really be seen on an ultrasound.

At my last ultrasound my spleen was enlarged , this has now returned to normal size which is good.

Also really frustrating as the sonographer just said oh fatty liver is so common now we don’t even usually mention it 😠

Can anyone tell me what parenchymal echogenicity means?

When I google it , it tells me steatosis rather than fibrosis

I find all this very strange when my fibroscan is suggest of F4 cirrhosis.

Surely it has to be overestimated 🤷‍♀️ and now I have to wait another 5 weeks to find out 😩.

[nash2 Partner]

Hi Amy

echogenicity means the image is brighter than normal suggesting that the liver has a lot of fat in it. Fibroscan measures stiffness so inflammation will raise the reading for example, but a CAP of 400 is as high as the scale goes so the readings can't be entirely relied upon and there are challenges with reading for someone with a high BMI. So a lot of uncertainty with the tests but you probably know you are at risk. If you want to pursue a better blood test you might consider this

fattyliverfoundation.org/li...

Wayne

[Amy190 in reply to nash2]

Thank you Wayne, I’ve asked for this blood test and my consultant told me it’s not available. He done a FIB4 score and it came back as 0.33 , very low score for fibrosis, however I know this is just an estimate rather than a diagnostic tool

[MINTVCX in reply to Amy190]

If you know your test values you can try yourself this:

mdcalc.com/nafld-non-alcoho...

And also this:

mdcalc.com/bard-score-nafld...

One more thing please rember not to eat before Fibroscan some hours (here in Poland it is at least 8 hours before test)

[nash2 Partner in reply to Amy190]

If you are in the US you can order the test yourself. They have a hepatologist who will do a telemedicine call with you to authorize it.

[Amy190 in reply to nash2]

Thank you , unfortunately I am not

[MINTVCX]

I assume it has been already done. But the condtion of the liver better shows INR, albumin, platelets, bilirubin rather than ALT, AST. Are they within normal range in your case?

You can check this “Liver function tests in identifying patients with liver disease"

ncbi.nlm.nih.gov/pmc/articl...

[Amy190 in reply to MINTVCX]

Thank you, yes all my bloods are entirely normal including liver functions , platelets, iron levels etc. All bloods associated with liver are perfectly normal - that’s what I can’t understand 🤷‍♀️

[nash2 Partner]

All of my blood tests were normal but I ended up with cirrhosis. If the progression is slow bloods can stay in normal ranges for many people until it gets quite serious.

[MINTVCX in reply to nash2]

Unfortunetly it can be that way in some cases that't way it is the worst situation because it is hard to react.If I can ask you if this is ok, besides fatty liver ultrasound was fine during that time? I mean for example enlarged spleen? And if platelets had been below 200? Or closed to low range (140-350)?

I am trying to find some pattern however I am aware every cases is different.

[Alterity]

Ultra Sounds don't work real well on NASH patience. My Dr. would get so frustrated with the Ultra sound because my insurance would not allow MRI when they wanted. My biopsy last week still showed Stage 4, the Ultra sound showed smooth liver, nothing wrong no nodules, when I have 6 nodules and have had them for years. They didn't just disappear. I didn't like the way my tech did my ultra sound either. My fiberscan was better then ever but I could feel it this time. 3 years ago I could not even feel the fiberscan hit me. My blood work has never showed anything, however a surgeon who had me opened up said it was the worst liver he had ever seen. I have lost 60 pounds and 90 since diagnosed so get an MRI and start losing weight to save your life.

[Amy190 in reply to Alterity]

Thank you , it’s very scary x

[Troutwhisperer]

Sorry I can’t answer your question. However, I can empathize with you. I just want to mention one of the newest blood tests named Liverfast developed by Fibronostics. It is respected and I am reading a good alternative to biopsy. It uses ten bio markers placed into an algorithm which then generates three scores. Fibrosis, Steatosis, and Activity (Inflammation) are the three scores. More info on Fibronostics website.

Best Wishes!!

Troutwhisperer