Help to analyse outcome of fibroscan (elastometry)

Hi does anyone have experience with elastometric tests - I have done two and after relapsing, my last one was "uninterpretable" - that is to say too heterogeneous. My doctor had to do it longer than usual (15 minutes instead of 4) and my measures went from 6 to 23 ... (as a result : KPa 10,3, IQR(KPa 4,3) EC( KPa) 8.7)
Can anyone help me?

[merryBe]

HR could help you yhere

[beatrice57]

HR? I am from france and I am not familiar with a lot of abreviations - thank you for your help

[copyman]

HR = hepatitis researcher is a MD that stops by here every once in awhile. he is an expert with the fibroscan. from the results you posted looks like you are a stage 2-3 and more important looks like you do NOT have cirrhosis. I believe 14kpa and above idicates cirrhosis.

[beatrice57]

so you can write to this HR MD??? thanks for your answer

[copyman]

no, there is no way to contact him but if he stops by soon he may comment on your post.

[willing]

it would definitely be helpful to get HR's take on this,  particularly reliability relative to the difficulty in getting consistent readings, but unfortunately he hasn't been around much lately. The first kPa looks like   your overall score (average or, more likely median  of the stiffness measurements taken)The  second (iqr or interquartile range is the difference between the 25 and 75th percentiles - a measure of spread. Sorry, but re the "EC" I have no idea. Overall a stiffness of 10,3 seems like a stage F2+, The spread of 4 looks pretty wide and may reflect the larger number of readings at different values.

Here's a few links to read up on until HR comes by (le premier en francais, c'est une invention francaise apres tout)

http://www.hepatoweb.com/fibroscan.php

(You need to register for to access this site)
http://www.medscape.com/viewarticle/557003

one of the original fibroscan pubs (long url)
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TD2-4B8J8YS-8&_user=4420&_coverDate=12%2F31%2F2003&_fmt=full&_orig=search&_cdi=5186&view=c&_acct=C000059607&_version=1&_urlVersion=0&_userid=4420&md5=bb7b1682da67a7e08d3c17ec3853aea3&ref=full#toc7

and an older MH post with comments by HR
http://www.medhelp.org/forums/hepatitis/messages/43807.html

[Hepatitis Researcher]

The short answer to your question is, that your doctor is using the fibroscan suboptimally.

Depending on intercostal width, operator positioning and pressure applied to the probe, subcutaneous fat , breathing position and instructions, overall positioning of patient to obtain wide intercostal access, there are "good' and bad individual shots as outcome of individual fibroscan attempts.
The biggest problem are reflections from partial secondary rib vibrations that generate interfering elastic waves that overlap with the main wave.

The machine has a built in image processor/  analyzer that is meant to discard improper readings.
But this algorithm is not critical or smart enough and quite frequently improper readings are accepted by the machine, leading to a wide spread of the "perceived" elastic wave speed that is the result of artifacts rather the liver condition.

A smart operator can see these improper pseudo-waves with ease, much better than the machine algorithm. And he will simply discard them and proceed until enough high quality readings are obtained.
The emphasis is on high quality, not on readings that you like.

Unfortunately, in a quest to eliminate "operator input" and "operator dependence" to standardize and "objectify" there is a trend - with a view towards  authority acceptance and a chance to shuff the work off to technicians with short term training,
to let the machine do all the deciding whats is a proper shot.
That leads, in more difficult cases ( since some patients are anatomically more suited for generating picture perfect elastic waves, others are quite hard) to a wide spread of "actual" values with a resulting uncertainty that could be easily avoided if the experienced operator had or would use the power of selecting the meaningful shots.
This is actually not so difficult, once the physics and the meaning of all details in the resulting "shot image" is fully understood.

Thus, without seeing the actual individual images, i could not say which are proper or not.

But after all, the MEDIAN  was chosen to eliminate many/most  of the artefactual results and chances are that you official median is indeed reflective of the fibrosis/stiffness of your liver.
Nevertheless, there is also the phenomenon of variability in the fibrosis/stiffness in slightly different areas -"investigated tissue cylinders" - that can be seen particularly in patients which probably had periods of active disease progression alternate with regression phases, which tends to "in-homogenize" the liver fibrosis. This is also the reason, why biopsies are quite often off by one stage and cirrhosis can be missed by biopsy, because a more regenerated area was hit by the small needle.

[Forseegood]

....huh....???? lol....hi HR, nice to see you! actually, I did get at least some of that, and I see it's best to have this done by someone who really knows what they are doing...have a great weekend!

[beatrice57]

i don't know, if you get this, but thank you for your explanations - maybe I can give you some more details - I did a fibroscan before in May of last year (I still was under treatment) here my results were very homogeneous and showed a non extensive fibrosis of F1 in metavir - kPa 5,6 IQR 1,3 with 3 intercostal spaces explored (I don't know, if I use the right english terminology?) , the realisation of the exam was easy and the succes rate was 100%
now, after relapsing I have got this result: KPa 10,3, IQR(KPa 4,3) EC( KPa) 8.7, and two intercostal spaces were explored - it was mentioned that the success rate was at 95% and the conditions were easy as well.
So can it be that certain inflammatory phenomena are accompanying a recent relaps and show up on a fibroscan? Is there a possibility to fax you the pictures?

[willing]

a progression from F1 to F2+ in less than a year seems very unsual, at least relative to the posts that appear here. In fact, it's common for relapsers to report improvement in their post-tx bx. If, as HR suggests, that last collection may have included a  number of misreadings with large values, it might be more informative to look at the full distribution of readings rather than rely on a one number summary. If the distribution is bimodal, with one cluster of good readings  around the expected value of 5-6 and another cluster of (probably spurious) readings at much higher values, the median isn't going to be a very representative number. Also, that medscape article, references " lt 20% interquartile ranges" as an indicator of the quality of their measurements - in your case 4.3/10.3 is more like 41% - all of which seems to  point to doing it over...

[beatrice57]

thank you - I will try to do it over again  (this has been suggested, nevertheless only in six months time - this is not very comfortable as you can imagine) and convince my Dr; to do it soon

[Adsan1280]

Hi HR...

I recently got a fibroscan done and my result was 7.9. Is that an F1 or F2 Level?

[willbb]

This thread is about 3 years old and  the poster you are asking is not here anymore.
Let me try to help....
7.9 kpa  would be considered an approx. early  to mid St. 2 on the scale..(that I will look for in a min.)   7.3--8.9  with an average of 8.2 was considered a stage 2 in correlating the values.

Often a biopsy is ordered  as an adjunct to FS...has you doctor ordered this also.
Welcome....
Will

[willbb]

Meant to add "early to mid st 2 "when comparing to the medavir biopsy scale..
Keeping in mind FS is prone to some degree of error as are all fibrosis markers...
Best...
Will

http://www.drfalkpharma.de/fileadmin/media/praesentationen/fs162/S4_P2.pdf

[willbb]

sorry "metavir scale"

[sirhic]

And thank you and if I may ask , after completing an ultra directed, liver biopsy with 0 fibro, 2 inflamation (inflammation) and 1 on nodual. Which puts me on hold for any tx at this time. Would it be of the wiser to get a secound view through fibro scan. From what I undersatand the guides and practices have improved.
Thank You
Christoph

[sirhic]

I guess I got to watch the dates.
Christoph

[Adsan1280]

Thanks willbb - I appreciate the information.