Aa
Fibroscan: Is it any good?
Hello again, fellow Medhelpers! Greetings from Buenos Aires, where we avidly await the beginning of spring. The winter down here in the Southern Hemisphere has been too long, and some people here think there won't be any summer at all this year. Global warming, melting ice caps, and all that sorta stuff. Argentines are hysterical. But it sure is unseasonably cold.
I hope I am still remembered by y'all with affection in spite of my past weird and occasionally wicked postings. I certainly haven't forgotten any of you dear people. You have been my port in the storm.
To give a quickie update, I am still without Tx, waiting for my hep MD to make up his mind what to do with me. I think these Argentine medics are kinda scared to do anything, afraid of scandal (can you see the headline: "American Tango Dancer Succumbs to Third-World Hepatitis Treatment"?).
The latest, and the real reason for this post (aside from my penchant for aggravating everyone with my dubious attempts at humor), is that they just got a Fibroscan machine at my hospital, trained a young female medic to run it, and I have been one of its first victims...er, I mean subjects.
The results are crazy and scary. It gave F2/F3. Now, just a year ago a biopsy and a FibroTC (tomography analyzed, see my images page), as well as many blood analyses and ecodopplers and whatnot, gave me as being F0/F1. How the heck can someone with almost normal hepatic enzymes (transaminases), otherwise totally normal blood tests, and scores of F0/F1 a year ago, suddenly be F2/F3? Is this possible? Is it credible? Or is their new Fibroscan machine a piece of junk, despite the cute operator?
Anybody out there with an opinion on this, my latest predicament?
All replies will be appreciated, and the one that is most helpful wins a free trip to Buenos Aires (by kayak and Moped) and three free tango lessons from yours truly (if I'm still above-ground).
Hugs.
Mike
I hope I am still remembered by y'all with affection in spite of my past weird and occasionally wicked postings. I certainly haven't forgotten any of you dear people. You have been my port in the storm.
To give a quickie update, I am still without Tx, waiting for my hep MD to make up his mind what to do with me. I think these Argentine medics are kinda scared to do anything, afraid of scandal (can you see the headline: "American Tango Dancer Succumbs to Third-World Hepatitis Treatment"?).
The latest, and the real reason for this post (aside from my penchant for aggravating everyone with my dubious attempts at humor), is that they just got a Fibroscan machine at my hospital, trained a young female medic to run it, and I have been one of its first victims...er, I mean subjects.
The results are crazy and scary. It gave F2/F3. Now, just a year ago a biopsy and a FibroTC (tomography analyzed, see my images page), as well as many blood analyses and ecodopplers and whatnot, gave me as being F0/F1. How the heck can someone with almost normal hepatic enzymes (transaminases), otherwise totally normal blood tests, and scores of F0/F1 a year ago, suddenly be F2/F3? Is this possible? Is it credible? Or is their new Fibroscan machine a piece of junk, despite the cute operator?
Anybody out there with an opinion on this, my latest predicament?
All replies will be appreciated, and the one that is most helpful wins a free trip to Buenos Aires (by kayak and Moped) and three free tango lessons from yours truly (if I'm still above-ground).
Hugs.
Mike
If you do not trust your FibroScan results I would repeat it.
Since it is non invasive it is easy to do.
Also would do a FibroSure blood test .
Since it is non invasive it is easy to do.
Also would do a FibroSure blood test .
I can't answer your question and am only hoping that there is a 'booby' prize of say, one tango lesson and one kayak 'round the lake and back???
It's lovely to see you poste again, and I can testify that similar strangely cold weather is happening in NZ (although this does happen every 4 years or so); it's still too cold to join the yakety-yak kayak club or kayak down the Puhoi River (mmm okay more of a tidal creek....).
I know many don't 'feel' when their liver starts seriously deteriorating, but I did. I had continual scans and blood tests 6 monthly, and things were slowley but definitely altering with both. I would repeat your tests in the near future as a comparison. A combination of scans and blood tests told me a story, combined with how I felt.
Hope you can wait for the newer drugs, but it is a hard call..
It's lovely to see you poste again, and I can testify that similar strangely cold weather is happening in NZ (although this does happen every 4 years or so); it's still too cold to join the yakety-yak kayak club or kayak down the Puhoi River (mmm okay more of a tidal creek....).
I know many don't 'feel' when their liver starts seriously deteriorating, but I did. I had continual scans and blood tests 6 monthly, and things were slowley but definitely altering with both. I would repeat your tests in the near future as a comparison. A combination of scans and blood tests told me a story, combined with how I felt.
Hope you can wait for the newer drugs, but it is a hard call..
From Clinical Care Options
"...Some advantages of elastography are that it can be performed in a nonfasting state, it can be performed rapidly with a usual examination time of fewer than 5 minutes, a median value can be calculated from 10 successful acquisitions, the prediction of disease recurrence has been validated in patients undergoing liver transplantation, the elastography score appears to correlate nicely with hepatic venous pressure gradient and the development of esophageal varices, and the score appears to increase with advancing model for end-stage liver disease or Childs-Pugh score, both signs of advancing cirrhosis.
However, possible confounders to the performance of successful and accurate elastography include excess visceral fat or adiposity; the development of hepatic steatosis, which can confound the measurements of elastography by increasing the stiffness of the liver; and cholestasis, which can also increase or alter the perceived stiffness of the liver.
This slide compares the predictive value of elastography vs other noninvasive tests. The table shows that the area under the receiver operating characteristic curve (AUROC), which is a measure of the performance characteristic of any given testing modality, appears to be comparable between elastography and some of the other serum markers, including APRI and FibroTest; indeed, these tests all appear to have an AUROC in the 80% range. However, when one combines FibroTest and elastography, the AUROC curve appears to improve to nearly 90%, and this may very well be the future of noninvasive testing. In other words, combining serum tests with elastography may result in superior performance regarding staging fibrosis. However, it should be cautioned that the largest multicenter study to date, presented at the 2009 European Association for the Study of the Liver meeting, found that hepatic elastography appeared to be ineffective at diagnosing significant fibrosis but more effective at excluding the presence of cirrhosis. Therefore, its discriminatory value for advanced fibrosis was less effective than its ability to exclude the presence of cirrhosis.
http://webcasting.clinicaloptions.com/p41385522?session=356153307
"...Some advantages of elastography are that it can be performed in a nonfasting state, it can be performed rapidly with a usual examination time of fewer than 5 minutes, a median value can be calculated from 10 successful acquisitions, the prediction of disease recurrence has been validated in patients undergoing liver transplantation, the elastography score appears to correlate nicely with hepatic venous pressure gradient and the development of esophageal varices, and the score appears to increase with advancing model for end-stage liver disease or Childs-Pugh score, both signs of advancing cirrhosis.
However, possible confounders to the performance of successful and accurate elastography include excess visceral fat or adiposity; the development of hepatic steatosis, which can confound the measurements of elastography by increasing the stiffness of the liver; and cholestasis, which can also increase or alter the perceived stiffness of the liver.
This slide compares the predictive value of elastography vs other noninvasive tests. The table shows that the area under the receiver operating characteristic curve (AUROC), which is a measure of the performance characteristic of any given testing modality, appears to be comparable between elastography and some of the other serum markers, including APRI and FibroTest; indeed, these tests all appear to have an AUROC in the 80% range. However, when one combines FibroTest and elastography, the AUROC curve appears to improve to nearly 90%, and this may very well be the future of noninvasive testing. In other words, combining serum tests with elastography may result in superior performance regarding staging fibrosis. However, it should be cautioned that the largest multicenter study to date, presented at the 2009 European Association for the Study of the Liver meeting, found that hepatic elastography appeared to be ineffective at diagnosing significant fibrosis but more effective at excluding the presence of cirrhosis. Therefore, its discriminatory value for advanced fibrosis was less effective than its ability to exclude the presence of cirrhosis.
http://webcasting.clinicaloptions.com/p41385522?session=356153307
It seems a pretty big jump that needs to be verified one way or the other. Knowing that around here we all consider the biopsy the 'gold standard' - is there any chance since they currently have you in watch and wait mode you can get another one? As said previously knowing for certain now that it is much better to treat while your stage is lower...if it has had that drastic a jump I'd sure want to know about it.
Enjoy the springtime we are just heading into fall but it feels like winter already and we've even just had snow already. Gross. Just plain gross!
Enjoy the springtime we are just heading into fall but it feels like winter already and we've even just had snow already. Gross. Just plain gross!
Hi, Bill! Thanks for your reply. Sure, I remember HR, a great guy.
Well, who knows if my hospital's operator is any good. She can't have much experience, since they just got the machine. But I tend to trust the folks over there, at least on the technical side.
Re having normal enzymes and still progressing, I've read that myself. But in my case it's not just the enzymes that have been low (50-70 range), but biopsy and FibroTC and ultrasound (checking liver size) and ecodopplers (looking at portal vein flow) that have been normal or nearly so. It's hard to believe that they were all wrong and the Fibroscan is right.
Of course, a year has passed. But can I be progressing that fast, from F1 to F3 in one year, after being stably F1 for years? Seems unlikely, don't you think?
Re treatment, my hep MD has all along been telling me that we are going to wait for the new Tx meds like protease inhibitor, as I am a bad subject for regular Tx because of my genotype (1b) and my age (65), and because I live alone. Now, however, because of these Fibroscan results, he's suddenly scared and is talking about Tx without PIs in a few months. I just don't know what to think.
I like your idea of doing break dancing at the hospital outside the doc's office. If I can get hold of some big speakers I may give it a try. And if you're on your way down here, take a pair of shorts. The summer is brutal.
Cheers!
Mike
Well, who knows if my hospital's operator is any good. She can't have much experience, since they just got the machine. But I tend to trust the folks over there, at least on the technical side.
Re having normal enzymes and still progressing, I've read that myself. But in my case it's not just the enzymes that have been low (50-70 range), but biopsy and FibroTC and ultrasound (checking liver size) and ecodopplers (looking at portal vein flow) that have been normal or nearly so. It's hard to believe that they were all wrong and the Fibroscan is right.
Of course, a year has passed. But can I be progressing that fast, from F1 to F3 in one year, after being stably F1 for years? Seems unlikely, don't you think?
Re treatment, my hep MD has all along been telling me that we are going to wait for the new Tx meds like protease inhibitor, as I am a bad subject for regular Tx because of my genotype (1b) and my age (65), and because I live alone. Now, however, because of these Fibroscan results, he's suddenly scared and is talking about Tx without PIs in a few months. I just don't know what to think.
I like your idea of doing break dancing at the hospital outside the doc's office. If I can get hold of some big speakers I may give it a try. And if you're on your way down here, take a pair of shorts. The summer is brutal.
Cheers!
Mike
Hi, Copyman! Thanks for answering. I like your averaging out to F1/F2. Makes sense.
The problem here is that my hep MD, who has all along been saying we will wait for the new drugs, is scared now by the Fibroscan results and says we should start regular Tx in a couple of months. He's done a flip. Somehow, I've got to talk him and the hospital into re-testing me with Fibroscan and/or doing other tests. They refuse to do a new biopsy before 3 years go by (1 1/2 years to wait).
I'm gonna try and get the folks in Sevilla who did the FibroTC for me a year ago to do another one now. But that won't be easy to do, and I'm not happy about all this radiation from the tomography. Matter of fact, if I have suddenly progressed to F3 from F1, I wonder if it isn't the radiation from the three CT scans last year that caused it.
It's a real predicament.
Cheers!
Mike
The problem here is that my hep MD, who has all along been saying we will wait for the new drugs, is scared now by the Fibroscan results and says we should start regular Tx in a couple of months. He's done a flip. Somehow, I've got to talk him and the hospital into re-testing me with Fibroscan and/or doing other tests. They refuse to do a new biopsy before 3 years go by (1 1/2 years to wait).
I'm gonna try and get the folks in Sevilla who did the FibroTC for me a year ago to do another one now. But that won't be easy to do, and I'm not happy about all this radiation from the tomography. Matter of fact, if I have suddenly progressed to F3 from F1, I wonder if it isn't the radiation from the three CT scans last year that caused it.
It's a real predicament.
Cheers!
Mike
Have an Answer?
You are reading content posted in the Hepatitis C Community
Learn about this treatable virus.
Getting tested for this viral infection.
3 key steps to getting on treatment.
4 steps to getting on therapy.
What you need to know about Hep C drugs.
How the drugs might affect you.
These tips may up your chances of a cure.
A list of national and international resources and hotlines to help connect you to needed health and medical services.
Herpes sores blister, then burst, scab and heal.
Herpes spreads by oral, vaginal and anal sex.
STIs are the most common cause of genital sores.
Condoms are the most effective way to prevent HIV and STDs.
PrEP is used by people with high risk to prevent HIV infection.
