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Avatar universal

CT and biopsy for diagosing cirrhosis

I want everyone to have every test they can to give them the max. info they need, this is why I am advocating the tomography/CTscan studies because it told me a lot that I didt know before the test. In ADDITION to your liver biopsy ( definately not in lieu of a biopsy. there is tons of evidence out there showing it is a good idea to have these studies done. Why not increase your info. with any test that can help? We all have heard biopsy is not perfect even tho it is the "gold standard" it can also MISS cirrhosis and only tells  you about liver structure not blood flow, this is just another tool in the arsenal. Cirrhosis CAN be determined through CT scans/tomography and in addition they get a look at your portal tract and bilary system in your liver which is VERY important info. for anyone with liver disease and something biopsy will NOT show you. It can spot developing problems in the early stages.I learned my spleen was slighty enlarged, something no other test has shown and a biopsy would miss. The idea that cirrhosis can not be determined by anything but a biopsy is not correct. There are other diagnostic tools we all can use and benefit from.

"Liver Biopsy
In some patients liver biopsy may not be necessary or safe and the diagnosis of cirrhosis can be made by other means. In some cases the combination of the patient
46 Responses
Avatar universal
I had an ultrasound is that the same thing? LOL stupid huh but I have no idea.

I have had every test the doc has even thought of at this point and FULLY believe the more info they have the better.  Pain, no pain...that is completely irrelevant.  Knowledge of what is going on is much more important than any of that little selfish worry I think.

Avatar universal
I had an ultrasound prior to tx too. It showed nothing and the doc said was "perfect". It is not the same thing. This was an abdominal CT scan with and without contrast (meaning you have to drink barium) I will call them today and ask what exactly the thing is, I know it takes pictures in slices and is a new machine. I aso know the SKILL of those doing the test and readig the results is very important but you being in NY I am sure you can find top notch people to read them, have Dr J or his people look at the pis for ya!
Avatar universal
"Liver Biopsy
In some patients liver biopsy may not be necessary or safe and the diagnosis of cirrhosis can be made by other means. In some cases the combination of the patient
85135 tn?1227293372
I had a contrasting CT done via an injection. How does a tomography differ?
I also had a bx later.
Avatar universal
Unfortunately I dont know enough about it to say yet. I will find out asap exacty what I had they told me "an abdominal CT scan with contrast" so thats all I know so far. That and the nurse saying it took MANY pictures in "slices" if that helps. Sounds to me like you had one done too.
I will find out the exact name of the machine, etc. when they open and call me back. I left a message, someone will call hopefuly today.
Avatar universal
Good Morning Friends, what I had done is a CT guided liver biopsy
than the next week they did an ultra sound, which to be honest I felt was odd since I had already had the CT, so I called the Doc to ask why, thats when she told me it was to look for tumors, cysts ETC. I really trust her knowledge, she is a Professor at UCLA, specialty is infectious disease, I feel I'm getting good care she sure as h*** is watching my labs, every other week I'm getting jabbed.
Avatar universal
You say: I learned my spleen was slighty enlarged, something no other test has shown and a biopsy would miss.
A top notch gastro would probably have discovered your enlarged spleen with palpation and, of course, that is one of the things that should be looked for following a diagnosis of liver disease. My experience has been that physical examination isn't nearly as thorough today as it was before all these tests became common place - a lot of these guys just don't have the skill set to perform detailed exams with their hands, eyes and ears. But, once in a while a physician does a very thorough physical exam and you know right away that it's quite different from the rest of the exams you've undergone. I have been examined by a lot of doctors over the last 10 years and that's my take on it. Mike
Avatar universal
As a stage 3, my doctor recommended alternating liver ultrasound, CAT Scan and MRI every six months. However, the recommendation was to screen for liver cancer and not to diagnose cirrhosis or attempt to stage liver fibrosis. Currently, I'm choosing to just do ultrasound and MRI because CAT scan involves more radiation.

Mike, earlier posted an article from the Mayo Clinic, that suggests the same. The last two posts in the thread are the relevant ones:
In part it reads:

"The last and most conclusive way to diagnose cirrhosis is a liver biopsy. A physician removes a tiny sample of liver tissue and examines it under a microscope. The procedure can be conducted using a needle biopsy technique that typically requires only local anesthesia."

Another interesting article is by Dr. Nezam Afdhal, a leading hepatologist and researcher into the dx of fibrosis/cirrhosis using non-invasive techniques. He is the head of the current Fibroscan trials in the U.S. It is interesting to note that he doesn't even mention CAT scan in this article:


Avatar universal
i think fibroscan is really good..even tho i hvent done it yet.
Avatar universal
I don't think you or I are trying to devalue the benefit of scans. We both know they can reveal very valuable information and I have had numerous scans and I assume you have as well. We're probably just confusing the issue. Different tests yield different information and hopefully the better doctors are using any and all tests that don't pose a significant risk and which are likely to give more information to the treating physician. We're almost getting to "my CT scan is better than your biopsy" and that's probably not where we want to go. Mike
Avatar universal
sunspot CT means computed tomography, the difference might stem from doing it with a contrast(dye injection) or without.  I think Paris must have had this, since she mentioned contrast and the discovery of her kidney stones.  the ultrasound does not use contrast as far as i know.

as for the fibroscan:
if i might add, the fibroscan mentioned earlier is only being used on subjects who had a liver biopsy within 6 months,  & have not treated for hcv, this is what I was told in an email by them. it is not readily available for all that ask for one.
I did not qualify for one because I treated, was SVR and did not have a bx within 6 months.
Avatar universal
Didnt say it was anything new, however, I have not heard on this board often if at all that the CT scan is VERY beneficial in showing condition of portal tract, spleen, bilary system,etc. and can indeed diagose cirrhosis nor do you hear here it is a good plan to get one. You only hear " get a biopsy get a biopsy" here. People who are geno 2 and 3 are often told they do not need a biopsy. From what I have learned, a CT scan would benefit ANYONE with liver issues and/or HCV and give you MORE info than just having a biopsy to determine the state of your liver struture.

If a new person to HCv asks about testing, I will be sure to suggest to them an ultrasound, biopsy AND abdominal CT scan studies along with their complete blood work from now on as they can have more info about their liver and that is a good thing.

I am just trying to share info, you dont have to be snippy or mean, Mike.
Avatar universal
No where have I said " my CT scan is better than your biopsy" or anything like that!

gold standard or not, biopsies are limited in the info. that they give the patient AND are KNOWN to miss things. Patients think if they have that biopsy thats all they need but CT scans offer a TON of info relevant to the HCV patient beyond the info a biopsy can offer. Everyone should get one if they possibly can, plus it is NONinvasive.

Have you had one?

Avatar universal
No offense to anyone, but I'll take the results of my biopsy over the results of my CT scan because in my case, my biopsy showed the fibrosis whereas the 2 different CT scans I've had (with and w/o contrast) showed nothing.  And the biopsy gave my doctor a better picture of what was actually going on internally. Also, I haven't had the Fibroscan, but I've had a Fibrospect test done, which rated me as between Stage 3-4.  Between both the biopsy and the Fibroscan showing around a Stage 3 and the CT scan showing nothing regarding fibrosis or cirrhosis, I think I'd rather ere on the side of caution.  I've had 3 separate biopsies and each one showed progressive fibrosis.  That was spread out over the years, not back to back or anything drastic like that. It's not that I want to be rated worse or anything, but I do want my doctor to know more accurately the truth of what's taking place in my body.  I'll still keep on getting the ultrasounds and the Alpha-Feto-Prot. tests as well.  Usually the docs order the ultrasounds-AFP. once a year. The rest of the time they're doing LFT's and viral loads. And approximately every 3-5 years a liver biopsy. I guess everyone has to do what they feel is best.

Avatar universal
any test can miss things, that is a given. that is why MDs use more than one diagnostic tool to rule out conditions and come to a dx.  
Some might not want an invasive procedure and others might not want radiation exposure plus the possible reaction to the dyes used.  It seems to be a matter of choosing the test that will answer the specific question you have. If you are looking for staging and presence of the hcv virus in the liver, need bx, if you are seeking answers to other things, choose the dx tool that will offer it.
Avatar universal
OK. That "someone" happens to be me.

I don't like to discuss my tx doctors, etc, but I see no harm in saying that I have had two Fibroscans, at one of the four centers.

One scan mid treatment, and one fairly recently (post treatment). The first can closely correlated with my biopsy of two years ago and staged me at "3". The second scan dropped me down either a whole stage or 3/4 of a stage, I'll have to find my notes which are somewhere under my socks which are probably under the dishes which I can't find :)

I truly think -- and so does the doctor who was supervising the scans -- that Fibroscan combined with newer blood markers now under investigation will soon revolutionize hep c treatment by affording everyone a fast, non-evasive way to measure liver damage. As stated, right now access is limited and FDA approval is still pending trial results.

-- Jim
Avatar universal
Jim, thanks for the info relating to fibroscan study, but if I read it correctly, it's for people who plan on getting biopsy in near future. I would assume they want to compare results with bx. Thanks anyhow.

ps what you mentioned in a post about the fibrosure, concerning the upper and lower value (can't remember your exact words)...my doc told me the same. If it comes out in the in between numbers, it wouldn't be useful info.

Avatar universal
I know that center must not have been Boston.

I guess if you know the drs personally or your dr knows them, you can squeeze a scan out of them.  

131817 tn?1209532911
Did you do the Fibroscan in a trial? Why did your dr give you these mid tx? Just trying to gather some points to bring up with my dr.
Avatar universal
Yes, that is what I am finding out. A CT scan can add very important info to the picture. For those told they dont need a biopsy or those watching and waiting, a CT scan is a great noninvasive diagostic tool. If you can get one, I would. I am blown away at how much I learned about the whole liver SYSTEM not just the structure. My doc has always said biopsy is "limited" and can miss important info. This is not to say people dont NEED a biopsy too, this is just another tool we can use to help us deal with this illness.
The skill of the person reading the results and the quality of the machine taking the pics is also very important.
Hope your hubby is doing ok and not feeling too bad.
Avatar universal

And points are being lost in the mix. My point in short is that MRI's, Ultrasound and CAT Scans are extremely useful BUT for primarily dx liver cancer and only secondarily for suggesting Cirrhosis and certainly not for a definitive diagnosis.

For a definitive diagnosis of Cirrhosis, the primary test currently is needle liver biopsy with Fibroscan and Blood markers now "circling" very close as Dr. Afdhal puts it in the previously cited article. And, also, as you say, in some cases no tests are needed if there's bleeding, etc, etc.

-- Jim
Avatar universal
Well I have a "top notch" gastro and the enlargement CAN be missed unless it is already enlarged ENOUGH to find in palpatation. Personally I am glad to know at the "slighty" enlarged stage that the CT scan showed.
Palpatation is the poorest, most rudimentary diagnostic tool of all, never depend on just that.
Avatar universal
Never said you did :) Just trying to make the distincition that some tests/procedures are better for one thing and others better for another.

As I stated earlier in the thread, you'll see that I have CAT scans as part of my liver cancer screening process but not to check for fibrosis or cirrhosis. That said, I prefer the MRI alternated with an Ultrasound on an annual basis, since CAT scans have more radiation. I'll probably throw in a CAT scan into the mix every five years if I find it necessary or if either the CAT scan or ultrasound suggests anything.

Frankly, I only initially raised this, because I'm hoping that your scan is wrong (suggestive not conclusive per the Mayo Clinic Article) and you don't have cirrhosis.

Wish you the best during these difficult times.

-- Jim
Avatar universal
You know when they told me my ultrasound came back fine I was sure it meant I didn't have to treat. The way they worded it...everything is perfect your fine...or whatever I was sure I had no fibrosis.

I think it's SO important that the DOCTOR take the time to explain what the tests DO and are FOR because once they said that I really thought I was like Stage 0 Grade 0.

Wrong wrong wrong as I learned over time LOL.

But...I do know of TWO separate people who have hep that both believe because their ultrasound came back fine...they don't have to worry about treating AT ALL.

And you simply cannot convince someone that they need more testing - they won't listen and say "no the doctor said my test was fine".  It's too bad so many people are out there like that.

Also..another friend with it said "my AST/ALT are fine I don't need any treatment".  Well that's good you are sober NOW but what about the 25 years that you weren't...do you think they were great then? That it didn't cause any damage?

It goes to show that ALL the tests you can get IN COORDINATION with the other tests...is the answer that you really really need.

I don't think one without the other is enough at all.
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