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

[jmjm530]

I'm not sure if my scans will be part of the trial data or not. My understading is that the scan data will be evaluated in numerous ways, so maybe I'll be included in some of the analysis and not in others. My treating doctor did not suggest the scans.  It was my idea and I made the arrangments with my doctor's blessing. "Trial" can be misleading. You go in for a couple of hours, meet with the doctor, nurse and scan technician and you're done. Scan takes less than five minutes.

[sfbaygirl]

No, I didn't know that! Thanks for the info. I would like to get one AFTER tx to see where I am, not sure the ins. will pay for it though.

[jmjm530]

I wouldn't 100% rule out Fibroscan regardless of any trial requirements. Say, for example, you went up to Boston as a private patient of Dr. A.  who runs the trials for a complete consultation.
I'm not saying you'll get a Fibroscan thrown in, but it might be worth a call to his office to find out if you're so motivated.

Also, if you're a geno 1, I personally wouldn't treat until you had either a liver biopsy or fibroscan that demonstrated significant fibrosis.  In about a year, SVR data should be available from the promising Vertex drug now in trial. We will know a whole lot more. That might be a reasonable time for those with little or no liver damage to make a treat or not to treat decision.

-- Jim

[NYgirl]

Don't know about fibro but know you aren't supposed to have any biopsy during treatment.  Just to mention in case somebody doesn't know that little factoid.

[jmjm530]

The decision -- treat or not -- or even the biopsy -- is not as clear cut with geno 2's. What the biopsy can add to the table, is as you suggest, how much time you reasonably can wait before treating.

I had a particularly hard time with treatment and its aftermath, so  I definitely have a watch n' wait bias as opposed to treat now. Still, I think my grey matter -- or what's left of it -- concurs with my bias. If you haven't checked out these recent threads on side effects -- both during and after tx -- you might.

http://www.medhelp.org/forums/Hepatitis/messages/41434.html
http://www.medhelp.org/forums/Hepatitis/messages/41439.html
http://www.medhelp.org/forums/Hepatitis/messages/41446.html
http://www.medhelp.org/forums/Hepatitis/messages/41492.html
http://www.medhelp.org/forums/Hepatitis/messages/41498.html
http://www.medhelp.org/forums/Hepatitis/messages/41506.html
http://www.medhelp.org/forums/Hepatitis/messages/41513.html
http://www.medhelp.org/forums/Hepatitis/messages/41515.html

I truly understand your wanting to get the virus "out" of you with haste but as I see it, it's not about the virus at all but about fibrotic progression. IMO the risks of tx can indeed potentially outweigh the benefits in many of those with little or no liver damage.

If you do decide to treat -- and you know you have little or no liver damage -- one reasonable strategy would be to try and limit your time on the tx drugs.

One study suggests that a 12-week "short-course" is as effective as 24 weeks in geno 2's who treat with Peg Intron (16 weeks if you treat with Pegasys) IF you are non-detectible at week 4.

If you buy into this strategy, of course you would want a very sensitive viral load test at week 4. Something that goes down to at least 50 IU/ml and preferable a test like Heptimax that goes down to 5 IU/ml.

So let's say you're non-detectible at week 4. Then you treat another 8 weeks and you're done. Let's say you're not detectible at week 4. Then you quit, and go into watch n' wait mode.  Maxium exposure to the tx drugs with this hypothetical strategy is 12 weeks.

The above is simply a theoretical tx strategy based on my own non-professional musings, but something definitely worthwhile to discuss with your doctor if it strikes a chord.

As far as Boston is concerned, don't know where on the East Coast you're from, but def worth the trip if you're thinking of a second opinion, which IMO is always a good idea prior to treating. I had three. Doesn't mean you have to treat up there, but just to be evaluated and perhaps get the scan.

Information here is good. Researching the internet is good. But sitting across from a top hepatologist brings something very new and special to the table. You probably read NYGirl's account of her visit with Dr. J in NY. Well, Afdhal is in the same league.

Anyway, I'm sure you'll end up making the decision that's best for you. We all look at this so very differently and often no rights or wrongs.

-- Jim

[Myown]

Hi Jim,
I'm geno 2, not 1. I know some would biopsy and wait if possible.

This gets so confusing. I know the other option is to get bx and if little or no damage, wait, as I stated above, but if interferon is still in the mixing bowl,its going to be a horror then also(as far as sx )and who really knows if the new stuff will even be as good or effective as current regimen, as time will only prove. I don't always buy into "New" is always "better." Sometimes it's the 3rd or 4th new test drug that makes the best medical breakthrough. My problem is I just want this thing out of me. Last time I checked my albumin and billirubin were normal, but all of a sudden lately, I felt a little itchy and I know that can be sign of cirrohsis. Now the itchiness went away last few days.  Also thyroid can cause itchiness and of course I also found info that can be a sign of cancer, so for my type of mind, I need to pull this thing out of me, so I don't continue to study my body daily as I walk pass every mirror and window reflection. I feel that the the longer it stays, maybe this gives it time to hide a little deeper, only to resurface again after we think we svr. All this occult stuff adds worry to the equation.But if or should say "when" i svr I will work hard with training my mind to believe it's over and done with for good.

Going up to boston is probably a good idea, but I just don't feel motivated. I know that lack of motivation can be a sign of depression, hope its not that. I'm leaning towards it's the "convienence" of traveling 10 minutes to my doctor.

Thanks for the info. I better get off computer and get outside and enjoy the day. We are actually having a day of low humidity. Not too many of those round these parts.