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Question for hepatitisresearcher about fibroscan
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Question for hepatitisresearcher about fibroscan

Referred to you by Jim, I was trying to find out about fibroscans. I am on week 21 of 48 of treatment. I never had a biopsy done due to the fact I am a fainter Dr. did not want to take the chance with bx but never mentioned a fibroscan. Can you give me any information?

Tracey
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Avatar_dr_m_tn
The best way to understand the use of the fibroscan procedure is to go to Pubmed and search for it, or google, or also there have been seveal threads here lately in which people gave info about it and I also described several details of its use here lately since I have such a machine for my research. You can also go to the website of echosens.com, the manufacturer of this medical device and see a movie on how it works.
It basically mesures fibrosis by measuring the physical stiffness of the liver, that is mainly caused by the presence of collagen fibers, particularly at higher stages of fibrosis.
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Avatar_m_tn
It sounded like she wanted a scan on tx that's why the
"referral" :)
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Avatar_m_tn
Oh, I see. She's in PA and you're in CA. Probably not a good match unless she wants to travel.
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Avatar_n_tn
Iam looking to see how to go about having the fibroscan done. I am on treatment now.

Tracey
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Avatar_dr_m_tn
see first if you need to.
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Avatar_n_tn
Can travei if need to.
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Avatar_dr_m_tn
After studying the world literature and the liver meetings for about 10 years regarding fibrosis potential therapies, several conclusions have emerged that basically boil down to a cocktail of measures - selected for minimal potential of negative side effects. Unless ongoing liver damage is present, it should be possible to slowly reverse a good portion  of the accumulated fibrosis in a SVR, or even to halt  further fibrosis in a non SVR in many cases. The green tea presentations recently given at the AASLD Boston meeting are just one of several good example of components of such a cocktail. The problem is that the field is so infested with misleading internet advertisement, that the useful measures and the unethical trash cannot be separated unless you understand the field in depth. That is also the reason that no specific advice can be given in the context of this forum that would exceed the well respected measures of intense weight control, proper diet and exercise and the avoidance of any liver toxicities if possible.
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Avatar_dr_m_tn
The principle of measuring liver fibrosis by measuring liver stiffness are the same with this method and the fibroscan ( Transient Elastometry). More so, it is the the velocity of the spread of a viscoelastic shear wave through the liver tissue that is measured by ultrasound following the spreading of this wave in the liver that is used in both methods so they are basically extremly similar. MRI seems a bit less practical in is use however, at first sight.

There is no question that the current bottleneck in the proper follow up of liver patients is the difficulty to assess degree of fibrosis with a method that can be used repeatedly and conveniently so that progress of any therapy aimed at changing fibrosis to the better can be followed. So if you would use any antifibrotic measures it woulc be very difficult to judge progress other than assessing fibrosis quantitatively from time to time to monitor progress, if any.

the mayo clinic is, unfortunately , not the cheapest spot to perform routine visits to. I was just there 3 wks ago since I was interested in getting a true glomerular filtration rate done.
The bill was 1300.00 for one injection of iothalamate and two blood and urine tests for that substance...
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92903_tn?1309908311
Hey HR, great to see you around. I wonder if you are able to comment on antifibrotic measures - what's going on in the research world, what pts can do on their own, and the likelyhood and timeline for a an old midly cirhotic fart like me to return to dancing the night away with sirens swooning at his feet -- ugh.. oooops... must have dosed off to dream land there.....
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92903_tn?1309908311
Thanks for the response. I respect the need to limit comments. The abstracts I found on the greeen tea seem to speak more toward improving fatty liver vs regrssing fibrosis. None the less, GT would seem a positive addition to the diet.

Hmmm... <b>intense</b> weight control, huh? Well, I ain't fat, but I'd be hard pressed to call this intense weight control either. BMI 23-24 .... I guess I better shed another 10 lbs.

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Avatar_n_tn
Has anybody tried the fibroscan unit.  Not looking forward to a biopsy.
Does it hurt, how much does the unit percuss into the ribspace (1 or 2 mm?)
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Avatar_n_tn
hi concerned,

i had a fibroscan done and found it to be painless.  the operator holds the sensor over your liver, either under your rib cage or between your ribs.  the sensor has a metal probe that is about the diameter of a pencil eraser that taps your skin.  the machine measures the rate a which the wave generated by the tap moves through your liver.  the more fibrosis in the liver, the faster the wave travels.  a healthy baby will have a reading of about 4.  an old cirrhotic like me was 48. anything above about 18 is an indication of cirrhosis.  the operator was only able to sense over a small area of the left lobe. my right lobe was damaged during an accident and is shriveled up. also he was not able to sense between my ribs because they are too close together.  i am reluctant to have a biposy because my liver has many surgical clips in it.

eric
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179856_tn?1333550962
The biopsy is painless as well - we were all scared before we had ours done too and didn't believe it wasn't going to be dreadful until we had our own done.
It is more reliable by far than the fibroscan.
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Avatar_m_tn
I've had both done. Fibroscan is both painless and non-evasive. Needle biopsy requires some sort of pre-medication and can have complications, sometimes serious, although usually not. My suggestion is that if you are able to get a Fibroscan, do that first. Then, depending on all sorts of variables -- Fibroscan result, blood tests, scans, etc, etc, -- later make a decision with your doctor on whether you need the needle biospy. The Fibroscan is considered very accurate.

-- Jim
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151263_tn?1243377877
If you do get a fibroscan, another thing that's really important is to ensure the technician running the machine and interpreting the results really knows what he/she is doing. This machine and this method of assessing fibrosis are pretty new (there are only a just a few locations in the US that have a fibroscan machine), so there isn't a large base of experienced operators to draw from yet. And the reason I know this is because "hepatitis researcher" (who is referenced in this old thread) more or less stated this a while back. If I were to get a fibroscan done, I'd go to hepatitis researcher to get it done (which I probably eventually will do). But I'd suspect there are other well qualified physicians capable of doing a quality job as well, although I wouldn't know who they are. We've gotten to know HR here over the past year or so, and I KNOW he knows what he's talking about. I think he was also the first american physician to be trained in France on the fibroscan machine and the first to have one at his own practice (if I'm not mistaken??).  
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Avatar_m_tn
Except for HR and I believe Dr. S. in Miami, all current (as of last year) Fibroscan machines are being run strictly by trial protocol. Trial protocol, for better or worse,  was developed to take operator error out of the loop with the intent that once approved, operators will simply follow a simple protocol and let the machine's software do the analysis.

So, assuming this carries over after FDA approval, I think most people can reasonably expect a good and accurate reading. I've had two Fibroscans done -- one during tx and one post tx -- both using trial protocol, which uses a single probe location with 12 (if I remember correctly) different "touches" which are then run through the computer software for some sort of median result after tossing out the high and low, or something like that.

My understanding from here is that HR does not use trial protocol and this is not a criticism but a statement. It's very possible that by not using trial protocol -- he uses mutliple probe points and what appears to be subjective analysis -- that he gets better readings than with trial protocol. Or it's possible that he doesn't because all the correlation data (with needle biopsy) is based on trial protocol.

But in any event -- HR aside -- I think trial Protocol is the way to go with Fibroscan, given the fact that it potentially will be used in many, many offices and therefore could potentially be subject to significant operator error/bias. We have that problem right now with needle biopsy.

-- Jim
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86075_tn?1238118691
We had this little tussle before (lol) and I learned something from your takes on this, because you have gotten the fibrocans in a trial setting and you were good enough to share your experience with the rest of us.

After reading everything you said, I think that in the future, they probably will be using a trial protocol like you say - for the masses. They can't expect a technician to be able to spontaneously read the probe's readings with the kind of expertise that HR does, HR being a doctor, specializing in liver and hepatitis research.

In a trial setting, from what I've read, and from what you say, the person doing the fibrosans  will be a technician after all.

And like you say, the tech's that will be doing these fibroscan's will be taking only smaller samples in a much more methodized way. Probing sampling way less of you liver then HR. As you have said, they are not doctors and could not give you blow by blows of what's happening to your liver (in terms of fibrosis) in the way that HR can. They will be tallying results from the computer read-out if I'm not mistaken, if I am, course correct me.

What HR does is essay, almost, your entire liver.... giving you a lot more information on your individual liver fibrosis level. He's had the machine for years now and knows the thing inside out.

On the other hand, a biopsy takes relatively few samples in one setting, that's why biopsies at one time might give you a higher reading,  at another biopsy, perhaps a lower reading, depending on the samples they took that day.

Course this is all individual, but many people don't have a uniform fibrosis level over their entire livers. I'm probably  going beyond my ken here on some of these points, I don't know all that much about this.....these are things I've read and heard, but I could be wrong on some of these points. HR could explain these subtleties and distinctions much better then I could, but I can't count on the fact that he will, he doesn't like to get into debates here at message boards.

At my fibroscan, I discovered, or HR discovered, that on some parts of my liver, big parts, relatively speaking, it was pretty good, going from a 1 or high 1, on other parts of my liver, I was a low 2 then a middle 2 on only a few parts of my liver, etc.

So I guess you would just have to *average out* the findings in my case, and conclude that I'm doing relatively well on most of it - at any rate.

All of us who took fibroscans with HR were pretty impressed with his expertise. And to have it done in such a nice setting, his office, overlooking the cityscape in the mountains, etc...but that might be beside the point. I've never had such a great "clinical" experience, put it that way. He's a very nice, caring man on top of all the expertise.

He might get pssed that I speak about him, but sometimes if he is challenged here, about some of the supplements that he likes, etc...or the fibroscans, etc...the guy just probably doesn't feel that he needs to justify himself here too much, or just to a point. He feels people are free to believe what they care to believe. He's been very, very successful in his particular fields....my own hepatalogists, all 3 of them, are very impressed with him and his knowledge. He knows 2 of them personally.

I am glad that you cleared up some stuff on fibroscans (I was hoping you would), though I know that if I had my druthers (and I realize that not everybody does) I would rather go with HR's fibroscan in a New York minute. I'm almost sure you'd feel the same way if you took yours with him, though of course, I'm just guessing.

And of course, comparing them to biopsy is a little like apples and oranges, fibroscans just measure fibrosis scores, they can't get the information that you can get from live tissue, like a biopsy can. A biopsy can tell you if you have fatty liver, etc. A fibroscan can't. But as far as how I would measure my fibrosis level or not? I'd much rather go with HR, like I said. Each to his own.
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86075_tn?1238118691
In re-reading your post, I see that we actually agree on most things. Sometimes when I'm pressed for time, I don't give posts a thorough reading, my bad, lol....
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86075_tn?1238118691
so pressed for time here this morning, writing fast, thinking fast, and the way my brain has been working lately, these are things I can ill afford, lol....anyway, after reading all you can on the fibroscan, and you can travel, and you are still interested, please email me at my profile...hope all is well...
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Avatar_m_tn
~I'`ll g``et `b`a`ck o`nt`hi`s `when `nmy` `compu`ter i`s `worki`ng b`et`t`er. `seems to have a min`d o`f` i`t`s o``wn =``````
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Avatar_m_tn
Forseegood: But as far as how I would measure my fibrosis level or not? I'd much rather go with HR, like I said. Each to his own.
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I never intended to turn this into a  "my scan is better than your (or HR's) scan" thing, although you sometimes seem intent upon. Simply pointing out the differences in the two scan processes.

What would I do personally, logistics and finances aside?

I'd probably get a scan with HR because I value his intellect and experience with the machine. But I'd also get a comparative scan using trial test protocol because that is the big comparative database present and future studies will draw on to draw conclusions. And if I had to choose one, I'd choose the trial test protocol, again because of the database.

Again, one of the main benefits/intents of Fibroscan is to offer a non-evasive device to gauge liver damage that can be repeated in large populations with a minimal amount of operator bias/error. Data that can then be used both for individual patient managment and future trial data -- for example tracking the efficacy of anti-fibrotic drugs (or even anti-fibrotic herbs) just to list two of many applications.

Please let's not let this disingergrate into "my scan is better than your scan". Le'ts just point out the differences and the reasoning behind the differences. And remember, HR posted here that he would probably adhere to trial protocol's in some capacity if and when they become standardized.

-- Jim



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Avatar_m_tn
I'd go with HR because he is a really swell guy. I always prefer a well reasoned approach based on objective criteria when it comes to matters like this. Mike
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Avatar_m_tn
MS: I'd go with HR because he is a really swell guy
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Sorry to disappoint but I think he's married but not sure.
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86075_tn?1238118691
I can see your points, I would just prefer HR not only because of his experience, but that he essays much more of the liver as well, but I see your points.
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Avatar_m_tn
I wasn't implying I want to marry the guy. We were talking about a procedure - a medical procedure, that is. Maybe you should reread the thread. Mike
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Avatar_m_tn
Just having a little fun with wordplay as I thought you were having some fun with Forsee's response, but sometimes hard to tell with your dry sense of humor.

-- Jim
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Avatar_m_tn
Yes, it was and is my sense of humor. You're not always that easy to read either Jim. All is well, Mike
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