Ultrasound missed fatty liver?

Is it possible for two ultrasounds to miss a fatty liver in my husband , but then a fibroscan to come back with a 300 CAP? I asked the liver doctor how it could miss that on ultrasound, and she said it does sometimes. But with that much fat showing on the fibroscan? Every comparison I read online to say that they’re often very similar, the two tests. Anyone else have ultrasound Miss fatty liver but fibroscan pick it up?

[nash2 Partner]

Ultrasound depends on the skill of the operator/radiologist. The only indication is if the liver looks "brighter" in the image. Opinions vary but we generally believe ultrasound can't diagnose fatty liver below 20 to 30 percent fat so most reported cases are actually quite fatty by the time the docs identify it using ultrasound.

[KC108 in reply to nash2]

My last 2 fibroscan CAP’s were 293 and 305. My last 2 ultrasounds were normal. I asked my Doctor about this also. He said he does not feel ultrasound is reliable for fatty liver as it’s very subjective. He feels one Doctor could look at an ultrasound and see increased echogenicity and another doctor could look at the same scan and think it looks normal. He also said if the fat is under 30% the ultrasound could appear normal, but you still could have fatty liver. My Dr. who is a hepatologist also told me he feels CAP is not reliable for quantifying the percentage of fat in your liver. He feels it is a good tool to indicate if you have fatty liver or not, but it’s not good at telling you how much fat. He told me with my CAP scores of 293 and 305 that I probably have a bit more fat then what is considered normal, but that they recently did a study where they took a fibroscan out to the streets in a truck type vehicle and asked people if they wanted a scan and 50% of the people had CAP scores that would put them in the fatty liver catagory. He was more concerned with the KPA, which for me was 6.7 and then 6.4, which he said is no scarring and he feels I am at very little risk for progression.

[nash2 Partner in reply to KC108]

You have an excellent doctor. All of that is correct from our perspective. You do likely have more fat in your liver than is considered normal but to prove that you would need a more accurate measurement.

[KC108 in reply to nash2]

Thank you for that reply. It is reassuring that you concur. Sometimes it’s hard to trust your Doctors because there is so much conflicting information out there. Particularly with charts showing fibroscan scores and results. My Dr. is using new fibroscan guidlines that I see others are not using. My doctor said that I would need an MRE to quantify the fat, but my insurance won’t approve it because the fibroscan is indicating no scarring and quantifying the amount of fat won’t change my treatment plan. He said he does not feel it’s necessary for me to have the MRE anyway based on all my test results. So far I have had ultrasounds, fibroscans, ultrasound elastography, CAT, scans and bloodwork. All indicating no Cirrhosis or advanced fibrosis and F0-F1. if my results were conflicting my doctor said he would push for the insurance approval of the MRE or a biobsy. Thanks again for your reply.