My annual Fibroscan - what I learned today

[dointime]

Hi All,

During my annual fibroscan today I noticed that the pings felt more uncomfortable than I remembered from last time, like something banging on my bottom right rib.  When it came to the result I was shocked to find that the number had increased by 2 in a year.  As I am in my early 60's I am at the age when my liver fibrosis, currently stage1, could just shoot up, so I am on alert for that.  An increase of 2 or more every year from now could mean not enough liver time for the new meds to arrive.

Anyway, the front of the machine is simple to read and showed a 70% accuracy for this test.  The operator said she would be happy to do it again and this time I did not feel any discomfort with the pings.  And lo and behold, the reading for this 2nd test was the same as last year!  The accuracy on the screen showed 100%.  

We discussed the discrepancy in the numbers.  The operator said it might have been that she had the probe at the wrong angle the first time and the wave was partially hitting off my bone, skewing the result to make my liver appear stiffer than it actually was.  This is an experienced operator and the same one as I had last year.  It was late afternoon and she said that she had been working the machine all day and her arm was tired, so she could easily have got the angle wrong the first time.  These probes are large heavy things.  

So - the things to note for anybody getting a fibroscan are -
a) if the pings are uncomfortable - they shouldn't be.
b) if the accuracy on the screen is not 100%.  
Although not always possible, an accuracy reading of 100% is obviously more reliable.  There is another parameter on the screen called the variance.  On my good reading it was 0.4% meaning that all the readings were within 0.4% of each other.  The higher this figure is, the bigger the difference in each individual ping reading and the less reliable your final score.

Well hope this adds a little bit to the knowledge and good luck with your fibroscans,
dointime
    
              

[mikesimon]

I learned something too.

Thanks for posting.

Mike

[willbb]

Thanks dointime . I have annual FS also and have felt slight "pings"  however my results correlated with the 3 biopsies I have had over the last decade.
Interesting ...

Will

[ceanothus]

Thank you for this very educational post! I've never had a fibroscan, but plan to start asking for one sometime after finishing tx.

[Bali05]

I had 6 Fibroscans so far , one of them in Germany and 5 in NYC.
Would be nice to have the thing FDA approved so Drs can write
you an actual medical report or test result.Instead you just get
like a verbal result. If they had to give you an official report in writing
they would make more of an effort to get it right in my opinion.
In Germany I got a printout from the machine listing everything
from success rate to each individual result of all ten readings
and also an image of the scan itself by which an experienced
operator can tell how well it targeted the liver.
Overall one always needs to remind oneself that even with a high
success rate the machine can be of by a stage or two which is
why it is mostly used to dx cirrhosis or very minor damage
the middle stages are iffy.
BTW , I read they are coming out with new FS machines even portable ones and with better probes.

[printze]

Thanks for the info I will be having one done soon, good to know.

[dointime]

I get my Fibroscan in UK.

I didn't get any printout but I got to see the screen with the individual result of all 10 readings.  That was it, no image.  My doc says that he does not go by the fibroscan result alone but by all the tests that I get, ie. bloods and ultrasound too.  He smiles like a crocodile when I talk about the accuracy of the fiboscan and then he offers me a biopsy - which he knows will shut me up, because it's a no-brainer which one I'm going to choose.    

By the way, I never tick 'best answer' on this forum because I think it is  stupid, but somehow I seem to have ticked your post for best answer without meaning to.  Sorry about that.

dointime  

[Bali05]

I monitored my tx with Fibroscan and it actually went up a stage.
Did two within a week on different days as baseline to make sure
I had a repeatable result which was F1. Than I did one
at wk12 still same result. wk48 however it was F1-F2 and
6 months post a 60wk tx borderline F2.
Also my enzymes always stayed in high normal range and kept going up towards the end of tx. My ALT was 72 @ EOT. Only once I stopped the meds did my ALT drop to the 20s.
To me that is evidence the meds did cause a burden on my liver
but very much worth it since  I am SVR.
I was thinking of doing another FS but enough already.
Instead I rather do ultrasounds for the occasional routine
checks. Just did one it is all clear.

Cheers
b

[jerialice]

hey there! i am trying to at  fibro scan but my doc says it's not reliable! i have a hemangioma which scares me cause i don't need a nick in one of those vessels!
anybody else have issues like that?

isn't there one other test? i have been thru tx 2x but never had a biopsy.
take care,
ja

[dointime]

bali05 - Thanks for the great info.  I think you must be the most experienced fibroscanner around here.  If I ever get back on tx I'll look out for my readings going up.  Congratulations on your SVR.

jerialice - hi.  There are blood tests like the Fibrosure.  No test is completely reliable on it's own, even a biopsy.  You have to look at the results of all your tests to get a reasonably accurate picture.  So in that light I think the fibroscan is useful.  When my readings have come out with 100% accuracy on the machine they have all been remarkably consistent.  However my understanding is that it is not always so easy to get a 100% accurate reading, one factor being if you are overweight around your liver area.  

Bali05 may be correct in that some stages may be more difficult than others for the machine to diagnose but you wouldn't know where you are if you have never had a biopsy.  If it were me I would do a Fibroscan, a Fibrosure and an ultrasound which can see if you have cirrhotic crinkles around the edges of your liver.  That along with your regular bloods should cover it pretty well.  You wouldn't get me for another biopsy - primitive and barbaric in my opinion, but for some situations I know it's the only alternative so I shouldn't really knock it.
Good luck,
dointime                    

[frijole]

Very interesting.  Sounds like there is a lot of room for operator error in a fibroscan, even with an experienced tech.  If they were available locally I might check into it, but they are not.

jeralice -- glad to see you around here.  Still close to treating but still not there, eh?  Do the doctors give you any indication of what they think your liver damage might be?  Well, hang in there, girl

bean

[angel149]

I have the Hep C Virus GenT 4 now for 25 years.
Reading all I can find about treatment, and have also a great doctor who is pretty much relaxed about this illness.
I have about 12 Million Virus.... and feel slight pain in my liver just under the ripp. I would like to join this forum for getting help and support to start this therapie as it seems the doctors themselfs are not really interested in emotional support. Anyway, - where to start?
My doctor wants to do some special thing, where I have to drink a liquid, and then he looks at my liver... this liquid can have strong sideeffects. Does anyone know about this? Sorry about the english, hope it is clear

[dointime]

You are more likely to get replies if you post a new thread with your question.  The way the forum works is that people try to stick to the original topic when adding to an ongoing thread.

dointime

[Bali05]

The only imaging procedures I know that involve swalloing a contrast agent
are to look at your gastrointestinal tract and not the liver.

As dointime said you should start a new thread.

b

[Aaron57]

Thought I'd chime in on this one as i just had my second FS last week .  20 weeks post P/R Tx ..

First FS pre Tx - 10.3 KPa (11-06-2010)

Second post Tx -  8.4 KPa (09-05-2012)

Different machines & obviously operators also ..

First FS - 100% accuracy - operator took 10 shots all Valid to get the results

Second FS - 71% accuracy - 14 shots to get 10 valid , 4 Invalid shots

All valid shots listed & 2 images included in the report ..

Already know I have some "fatty liver" from a USG , BMI good , ... definitely a bit confused about the inconsistency of Valid readings from the second FS .. however quite happy to see a change to F1-2 where I was F2-3 ..... for what it's worth .. that's my story & I'm sticking to it : )

FS - $150 charge here ... I'll check again in 6 months or a year ..... if my Tx turns out to be successful .. will know that at the end of June .... at 12 weeks Post Tx - Und .. all fingers & toes crossed -  

Cheers, Aaron

[dointime]

Thanks Aaron, that's really interesting.  I wish there were more people with fibroscan results to post then we could get a better idea of how to interpret them.

I did notice that when I got the 70% accuracy reading, all the shots came in at round about 5 or 6, even the shots that were shown as valid.  However for the 100% accuracy reading all the shots came in at about 3 something.  So my conclusion was that you can't trust any of the shots in a reading that is not 100% accurate.

I am leaning towards the conclusion that the Fibroscan is a much more blunt instrument than I previously thought.  Maybe it's a case of under 5 and you are stage 1, over 10 and you have advanced fibrosis, in the middle who knows.

Also, the operator seems to be able to make a bigger difference to the readings than I like.  Maybe it takes a very skilled operator to get readings you can trust down to the mark.

Well just my thoughts here.  We'd need to have a lot more examples of readings to get a better idea of this machine.  For my money I'll still take it to a biopsy any day.

dointime      

[willbb]

Came across this today at medscape:
Will

http://www.medscape.com/viewarticle/762116_4


Steatosis according to Brunt did not influence liver stiffness. However, the Brunt classification is not well adapted to viral hepatitis and this poses a limitation to our study, especially concerning the statistical analysis.

Moreover, in the first TE studies the influence of inflammation was not investigated, but reported in later studies.[31,34,35,38,44–47] In all METAVIR stages, liver stiffness is significantly influenced by inflammation as well as by serum ALT level. In the lower stages of fibrosis F1 and F2, inflammation seems to be an important factor associated with increasing liver stiffness, therefore causing a decrease in performance of fibrosis assessment with TE, and considerable overlap between stages F1 and F2. Also in these studies, and in our study, there was an imbalanced distribution of fibrosis, with an overrepresentation of stages F1 and F2, but only few F0 patients. A limitation was the use of liver biopsies with inadequate length, according to international standards.

According to our study results, TE can be used in clinical practice for the evaluation of fibrosis and cirrhosis. When liver stiffness equals or exceeds 14 kPa, this can be regarded as confirmative for cirrhosis, in both CHB and CHC patients. Severe fibrosis is with high probability present when liver stiffness is between 9 and 14 kPa in CHB patients, and between 8 and 14 kPa for CHC patients. However, for the diagnosis of stage F ≤ 2, the performance of TE is suboptimal and less reliable, and inflammation increases liver stiffness. In all patients the determination of ALT levels, as an indirect parameter for inflammation, is therefore especially important because inflammation influences liver stiffness. We conclude that TE is an accurate tool to assess severe fibrosis (stages F3 and F4) in CHB and CHC patients.

[willbb]

I wish there were more people with fibroscan results to post then we could get a better idea of how to interpret them.
---------------------------------------------------------------

Hi DT ..nice to see you--

mine were :

   6.1 Kpa ( 2004 )  
correlated with biopsy shortly after  at ST 0-11

(2008 )  6.6    corelated with bx..  St . 0--1

(2010 )   6.7    corelated with bx.. St 1

Hope all is well..
Will

[dointime]

Hi Will, many thanks for chipping in here with your results.

I've only ever had 1 biopsy in 2007 which came out at stage 1,  My Fibroscan at the same time was 4.1Kpa.  

So taking both our results, stage 1 can come out on the Fibroscan as anything from my lowest this year at 3.3Kpa to your highest at 6.7Kpa.  

The medscape article would seem to be correct then.  The machine is suboptimal for the lower stages.  My ALT has always been below 40.  Do you have your average ALT values over the years?  

I must say I am kinda losing faith in the Fibroscan as an early warning that my fibrosis is progressing.  I wouldn't really trust it after what I have learned from this until the reading went above 8.  However for me it's academic really because there's no tx out there right now that has a chance of working for me.  Even if I get a 14 on the Fibroscan I'm out of options until we get an effective ifn free tx.

By the way, I'm still looking forward to finding out what drugs you got on your trial.  Never mind the hepc, the suspense must be killing you.

dointime

      

      

[willbb]

Actulally the St. 1 has helped relieve some of the "suspense " :)
Unblinding in July. .I will let you know ...
Stay well..
Will

[willbb]

When looking over the thread again I see missed your question:

"Do you have your average ALT values over the years? "
They have usually  averaged approx. 2x normal   60-80   for quite some time .

Also .the last biospsy result I posted above was done just recently  Mar.of this year.. I mis-typed. I did not have one in 2010

Hope that helps.

Be well..
Will  

[willbb]

The FS was done in 2010 (at trial) and was 6.7 Kpa as I mentioned.
Will

[dointime]

Thanks for posting this further info.  So there's the possibility that the medscape article is correct.  Higher ALT values, ie. higher inflammation, results in a higher Fibroscan reading for the same stage of fibrosis.

Well, still not enough results to go on, but at least we made a start on interpreting the Fibroscan readings.  

I've been thinking it's a shame that so many insurance companies in the US demand a biopsy rather than a fibroscan.  Maybe they should send  somebody from the office to do a bit of field research and have a biopsy themselves.  Then they might change their minds on what is reasonable to ask for.  Oh but wait a minute!  Maybe more people would go for it then and that would cost them more.  Duh.  

dointime            

[Diamando6]

Mine fibroscan results were 18 KPa, and Doc. told me that it could be related to begining of chirrosis!