CT and biopsy for diagosing cirrhosis

[Kalio1]

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

[mikesimon]

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

[jmjm530]

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:
http://www.medhelp.org/forums/Hepatitis/messages/42020.html
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:

http://www.natap.org/2005/HCV/080905_01.htm

[niceguy2007]

i think fibroscan is really good..even tho i hvent done it yet.

[Kalio1]

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.

[mikesimon]

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

[cuteus]

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.