cirrhosis imaging

[edcali55]

What is the most sensitive imaging tools (ultrasound, ct scan or MRI)?

[edcali55]

Do you think I should ask my doctor for a biopsy?

[fntn]

Your likelihood of cirrhosis is very low. What you might want to discuss with your doctor is the progression ranking possibilities of multiple Fibroscan tests. Even if the accuracy in mid-level fibrosis is a little uncertain, can it gauge whether or not you're getting better or worse over a given period of time, using multiple tests as a ranking score. Basically, it doesn't matter if the stage is gauged perfectly, but predicting a decreasing/increasing level of chronic liver disease is important. I'm curious about this myself. Kinda like a weight scale that's off calibration - but it will still tell you if your gaining or losing weight.

[edcali55]

Thanks for your detailed and very educational response.  Based on the score, can I assume that the likelihood of cirrhosis is very low?

[fntn]

Fibroscan can do a good job in sorting people into three general fibrosis levels: (low) none-to-minimal, (medium) mid-grade but indeterminate and (high) advanced-to-cirrhotic. The lower level is basically fibrosis stage-1 or less and it's cutoff is up to 6 kPa. The mid-grade level covers fibrosis stages-2 & -3 and it ranges greater then 6 kPa but less than 12 kPa. The highest level is fibrosis stage-4 up through cirrhosis and the cutoff starts at greater than 12 kPa on up to 70 kPa or more (very advanced cirrhosis). Placement into either the lower or higher levels is considered to be accurate (biopsies are generally not needed), but the Fibroscan procedure has difficulties in sorting out the medium fibrosis stages.

So you were tested at a scope of 10.4 which places you somewhere in the mid-grade fibrosis level. But unfortunately, the accuracy of Fibroscan in assessing your actual fibrosis stage is poorest in this range. So it's difficult to really say whether you're a low stage-2 or high stage-3, but only just that you are within this range. If your doctor was planning on a treatment/therapy based on an accurate staging assessment within this range, then a liver biopsy might be needed.

Keep in mind that the Fibroscan can be additionally limited by several other things. One's BMI (greater than 30) can further reduce the accuracy. Whether or not you are suffering from an acute vs chronic liver disease, and high grade inflammation, can alter things as well. And there are a few other issues, but these first two are the most likely ones, if I'm remembering correctly. Lastly, the form of your liver disease will determine the actual cutoff values for the various fibrosis stages - i.e. viral hep vs NASH vs cholestasis, etc. But these variations in the cutoff levels aren't huge - and the baseline cutoffs mentioned above are typical values and good to use generically.

Let us know how your appointment with your GI goes. Many people are interested in this new Fibroscan testing. The invasive needle biopsy isn't in anyone's bucket list I'm sure. Take care.

[edcali55]

Dear fntn

Hope all is well.

I had my GI visit a couple of weeks ago and recommeded fibroscan. Today did fibroscan and the scope was 10.4.  I have not talked to my GI yet about this.  Any insight on what this scope indicates?  

[fntn]

Your numbers are normal except for your WBC level but that only mildly depressed. These levels could be affected by cirrhosis but only in it's advanced stages, which you don't have. Hope you GI visit goes well.

[edcali55]

An update:
I did blood work last week and some of the numbers worry me, although my Dr does not see them worrisome.  

Wbc = 3.5  lab ref = (4.2 - 10.8)
RBC ='14.1 lab ref =(14.0 - 18.0)
Platelets = 144 lab ref =(130-400)
Creatinine = 0.8 lab ref =(0.7-1.2)

I have an appointment with a GI in 2 weeks.  I hope people here might be helpful. Any input is very much appreciated.

[fntn]

It seems your dctors are happy with your blood work matching what they via US. Any advanced liver diasease will likely have shown itself during your US procedure or at least in some of your serum numbers. But if your doc's happy, you should be too ... but I know that's a tough one.

You might suggest a CT or MRI next time your docfor wants to do a followup peek, probably in 6 months to a year. He might go for that. Meanwhile, exercise and eatting right is your part of the deal. Take care.

[edcali55]

Many thanks for your comment. I have fatty liver (diagnosed by US). My blood tests (including camp and liver function test) are all normal, but cannot sleep at night and have muscle movements.  However, both my internist and GI doctors insist that I just have fatty liver nothing more.  I would like to have either ct or mri to see if there is anything more than just fatty liver.  That was the rationale behind my questions. Thanks again for the help.

[fntn]

Imaging is kind of a secondary tool in the diagnostic process, a good doctor will usually know what's up without them. Morphology/texture changes can be detected with all three, US being the cheapest thus preferred. But cirrhosis is a blood flow disruption type of disease, so CT an MRI imaging coupled with contrast enhancement to track perfusion changes can lend additional information. Also, any cancerous issues, caused by the cirrhosis, can be detected easily by US but will usually need CT or MRI to further characterize which pathology is likely to be involved.