Conflicting reports. What would you do?

[Ilovejoe]

How much more reliable (if any) is a MRI with elastrography over an ultrasound of upper right quadrant?

Just got home from appt. with hepatologist. He read radiologist’s findings report stating cirrhotic liver. He had the films (pics) on the computer in the the room and didn’t think it showed that or nodular contour (I totally didn’t know what I was looking at). He did say I’m not a radiologist though but…

The look on my face must have alarmed him so he suggested having a MRI with elastrography if my insurance would cover it.

I got the impression he is happy with my progress. My bloodwork has been excellent the last year and my recent metavir score of F0-F1 (same as February 2021) has him pleased.

I am looking into the new test. Your thoughts?

PS

All previous ultrasounds of upper right quadrant have been good!

[mtk0925]

I would think that if all scans prior were normal than this should be examined further. Possibly biopsy? I haven’t heard much about mris with liver dx but I would think get to the bottom of it and get and biopsy

[Ilovejoe in reply to mtk0925]

Thanks for your input. Doc doesnt recommended biopsy unless I really want it. He’d rather do a less invasive test and I’d rather at this point because I had an issue with bleeding during an operation that left me so. so close to transfusion. It might be where I’ll go though if insurance approves that over MRI.

[nash2 Partner]

An MRE (MRI with elastography) is far superior to an ultrasound. The US can't really detect fibrosis but one thing it can show is the shadow of the liver on the abdominal wall. A healthy liver will be smooth and with cirrhosis you can see the shadow of the nodules. He was trying not to trash the radiologist with his comment but the only real value of US for NAFLD/NASH is to look for liver cancer. MRE will give you more information than Fibroscan so a good step if your insurance will cover it.

[Ilovejoe in reply to nash2]

Thanks for getting back to me. As I also discussed with hepatologist was what the radiologist also stated in report that my liver is normal size, surface contour is nodular, and diffuse coarse Ed heterogeneous echo texture suggesting underlying cirrhotic changes. 😢. Six months ago and before that when I was F2 and F3 it was smooth. I’ve done everything I needed to do to reverse NASH (lost weight, eat clean, get steps, etc.). I am now off high blood pressure, reflux medicine as well as cholesterol medicine. All I take is URSODOIL for PBC and Pepcid (coffee lover). I’m so scared. I want to live a long healthy life and the word cirrhosis is stressing me big time. I can’t wait to see if approved. Thanks again Wayne, you are so kind to help us.

[nash2 Partner in reply to Ilovejoe]

I didn't realize that you had been diagnosed with PBC. Most people here have NASH so you are dealing with an autoimmune problem rather than fatty liver. URSO is a typical treatment but obeticholic acid is also an approved therapy. The best group I know of for help with that is this one.

pbcers.org/

Happy to have you here but we aren't your best source of support for PBC.

Wayne

[Ilovejoe in reply to nash2]

I have both Wayne. Both diagnosed February 2020. I responded to URSODOIL immediately and normal numbers in six month check up. NASH was diagnosed with US with elastrography (F2 and some F3. In six months it was F1 and a year later F0-F1 as it was this past November. Hepatologist more concerned about NASH I believe because he said the PBC was early. As I said before I have no symptoms of both and I’m active and busy daily. Trying to find a hospital with MRE machine. Thanks again for getting back to me. I do belong to PBCers and NASH groups.have a great day. It’s beautiful here in PA

[nash2 Partner in reply to Ilovejoe]

That is a hard combo but it sounds like you are doing pretty well. Being an educated patient is the best defense.

[Alterity in reply to Ilovejoe]

I'm in Ohio and there are only two places that have the MRI with elasticity. Cleveland Clinc and OSU. I broke the machine at OSU first time and was there for 2 hours until they gave up. I went back about 24 days later and had it done. That was 2 years ago, so more machines may be out there by now.

[mtk0925]

I would try hard not stress. Are you feeling ok over all? It may just be a user error on the scan.

[Ilovejoe in reply to mtk0925]

Thanks for your optimism. My husband is trying his best to keep me from losing it. It’s just that I’m scared to hear this possibility. I am symptom free of two liver diseases. People can’t believe it. I am active (babysit 1 1/2 year old 2x week plus have him for sleepovers, keep busy with house (recently retired after 27 years teaching) and I cook and entertain very often. I had three reports with reversing fibrosis (F0-F1 last two) and good ultrasounds (smooth surface).. I haven’t done anything different except use a little more salt now. I never have healthy concerns (lost 35 pounds and off all meds except autoimmune)! I out last year husband who is the same age (65) and he is not on one medicine! LOL. I can’t wait to get to the bottom of this. I want a nice birthday gift this year (December 25th)! You are kind to reply. I will try harder not to stress. Hepatologist said he’s pleased so I should think more on that side.💐