Exploring Fibroscan (Ultrasound Elastography): A Non-Invasive Revolution to Liver Biopsy | Max Hospital

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FibroScan® Liver Scan: An Alternative to Liver Biopsy

By Dr. Ayush Dhingra in Gastroenterology, Hepatology & Endoscopy

Jan 31 , 2024 | 10 min read

The liver is responsible for filtering the blood, removing toxins, and metabolizing drugs. It is an irreplaceable and vital organ that is needed for our body to work properly. If your liver is damaged or injured, it becomes difficult for the body to perform needed tasks. As a result, a person whose liver is severely injured will gradually become extremely ill.

Traditionally, assessing the health of the liver has involved invasive procedures such as liver biopsy, which come with inherent risks and discomfort. However, in recent years, a groundbreaking technology, FibroScan®, has emerged, revolutionizing the way liver health is evaluated. It is a non-invasive method that has quickly become a game-changer in the realm of hepatology, providing a safer and more efficient means of assessing liver fibrosis and steatosis.

In this article, we will understand FibroScan liver scan, exploring its applications, benefits, and guide you through the procedure, offering insights into interpreting the results. Read on

Liver Biopsy vs FibroScan Liver Scan

Up until recently, the only way that doctors could inspect a patient’s liver was through a medical procedure known as a liver biopsy. In this operation, a small portion of the patient’s liver is removed. This sample is then studied in a laboratory and the amounts of scar tissue and fatty deposits are deduced.  However, liver biopsies are expensive, invasive, and are often associated with complications.

On the other hand, ultrasound elastography, commonly known by the brand name FibroScan®, is a non-invasive device that allows doctors to figure out the amounts of scar tissue and fatty tissue present in the liver. A FibroScan® machine works like an ultrasound. A small handheld probe is placed on the lower right section of the patient’s ribcage. This probe then emits a shear wave into the patient’s body. The machine records the waves reflected off the patient’s liver and calculates the amounts of scar tissue present in the liver, displaying the results on a screen.

The FibroScan liver scan drastically increases the feasibility of liver monitoring for at-risk patients. Many doctors feel that it will increase the number of early diagnoses, hence allowing patients to get treatment before serious complications set in.

As the FibroScan liver scan is a non-invasive test requiring no incisions, patients can return home immediately after the scan. The results of a liver biopsy can take days whereas the results of a FibroScan are instantly available.

Applications of FibroScan

FibroScan has become invaluable in diagnosing and monitoring various liver conditions, helping healthcare providers and patients better understand their liver health. The FibroScan liver scan has a number of applications, such as:

Liver Fibrosis Assessment

Liver fibrosis is a condition in which healthy liver tissue is gradually replaced by scar tissue. It is often a result of chronic liver diseases such as hepatitis and cirrhosis. Fibrosis can progress over time, leading to reduced liver function and, in severe cases, cirrhosis. Early detection of liver fibrosis is crucial, as it allows for timely intervention and the prevention of further liver damage. Identifying fibrosis in its initial stages offers the best chances for successful treatment and lifestyle changes.

How FibroScan Measures Fibrosis?

FibroScan uses transient elastography to measure the stiffness of liver tissue. The stiffer the liver tissue, the more likely fibrosis is present. The results are typically expressed as a numerical value, helping healthcare professionals grade the severity of fibrosis.

Fatty Liver Assessment

Liver steatosis, commonly known as fatty liver disease, is characterized by the accumulation of fat in liver cells. It can be caused by various factors, including obesity, excessive alcohol consumption, and certain medications. Fatty liver disease can range from benign to severe, and early detection is essential for preventing progression to more severe forms of liver disease.

Role of FibroScan in Detecting Fatty Liver

FibroScan can also assess liver steatosis by measuring the liver's attenuation coefficient, which indicates the presence and severity of fat in liver tissue. This provides valuable information about the extent of fat accumulation in the liver.

Monitoring Liver Diseases

FibroScan is not limited to assessing fibrosis and steatosis alone. It is also a valuable tool for monitoring the progression and severity of various liver diseases. This includes viral hepatitis, alcoholic liver disease, non-alcoholic fatty liver disease (NAFLD), and liver cirrhosis, among others.

How FibroScan Aids in Monitoring these Conditions?

For patients with chronic liver diseases, regular FibroScan tests can provide crucial data on disease progression and the effectiveness of treatment. By tracking changes in liver stiffness or fat content over time, healthcare providers can make informed decisions about adjusting treatment plans and lifestyle recommendations.

What are the Benefits of FibroScan?

FibroScan liver scan offers a myriad of benefits, making it a preferred method for assessing liver health in comparison to traditional invasive procedures. The advantages of this non-invasive technology include the following:

Non-Invasive Nature

Unlike liver biopsies, which involve the insertion of a needle into the liver to collect tissue samples, FibroScan is entirely non-invasive. This eliminates the need for painful and risky procedures, making it a much more patient-friendly option.

Speed and Efficiency

Time-saving: FibroScan is a quick procedure, often taking only a matter of minutes to complete. In contrast, a liver biopsy involves a lengthy process, including pre-operative preparations and post-operative recovery, which can take days.

Safety and Minimal Discomfort

Patients typically experience minimal discomfort during a FibroScan. There is no need for anesthesia or sedation, and the procedure is performed on an outpatient basis. This eliminates the risk of complications associated with anesthesia or surgical procedures.

Wide Applicability

FibroScan is well-suited for a wide range of patients, including those with co-existing medical conditions or advanced age, who may not be good candidates for invasive procedures. It is particularly useful in pediatric patients, where liver biopsies can be challenging.

Repeatable and Trackable

FibroScan can be performed multiple times over a patient's treatment journey, allowing healthcare providers to monitor the progression of liver disease or the effectiveness of interventions without subjecting patients to the risks associated with repeated biopsies.

Reduced Healthcare Costs

The non-invasive nature of FibroScan reduces healthcare costs associated with lengthy hospital stays, anesthesia, and post-operative care that often accompanies liver biopsies.

How to Prepare for a FibroScan Liver Scan?

Preparing for a FibroScan is a relatively straightforward process that requires some basic considerations to ensure the accuracy of the test. Here's a guide on how to prepare for a FibroScan:

Pre-scan Instructions

  • Appointment scheduling: Contact your healthcare provider or the clinic where the FibroScan will be performed to schedule an appointment. Ensure you have the date and time confirmed.
  • Dress appropriately: Wear comfortable, loose-fitting clothing. It's important to expose the upper right side of your abdomen, as this is where the FibroScan probe will be placed.
  • Medication disclosure: Inform your doctor of all medications you are currently taking, including prescription, over-the-counter, and supplements. Some medications can affect liver stiffness measurements.

Dietary Considerations

  • Fasting requirements: In most cases, there are no strict fasting requirements for a FibroScan. However, it's a good idea to have a light meal a few hours before the test, especially if you have dietary restrictions or medical conditions that require eating at specific times. This can help prevent lightheadedness or fatigue during the procedure.
  • Avoid heavy meals: Avoid heavy, fatty, or large meals immediately before the FibroScan. A large meal can affect the results by temporarily increasing liver stiffness.

Potential Contraindications

  • Pregnancy: If someone is pregnant or suspect they might be pregnant, it is important  to inform the doctor and the technician performing the FibroScan. In some cases, alternative tests or additional precautions may be necessary.
  • Metallic implants: If someone has any metallic implants, such as a pacemaker, it is important that they inform the technician, as metallic implants can interfere with the FibroScan procedure.
  • Medical conditions: If someone has specific medical conditions or concerns that could affect the FibroScan procedure or its results, it is important to discuss them with the doctor beforehand.

How Long Does the Procedure Take?

The duration of a FibroScan procedure is relatively short, typically taking only a few minutes to complete. This quick and efficient process is one of the advantages of FibroScan over more time-consuming and invasive methods like liver biopsies. The brevity of the procedure contributes to its convenience and patient-friendliness, making it an attractive option for assessing liver health.

How to Interpret FibroScan Results?

Understanding the results of a FibroScan is crucial for both doctors and patients, as it provides valuable insights into the health of the liver and guides decisions regarding treatment and lifestyle changes. Here's an overview of how FibroScan results are to be interpreted:

Liver Stiffness Measurement (LSM)

FibroScan results are typically presented as a numerical value, which is known as the liver stiffness measurement (LSM). This value is measured in kilopascals (kPa). A higher LSM indicates greater liver stiffness, which is often associated with more advanced liver fibrosis. The specific LSM values are typically grouped into stages, ranging from F0 (no fibrosis) to F4 (cirrhosis).

Attenuation Coefficient (CAP)

In cases of steatosis assessment, the FibroScan provides an attenuation coefficient (CAP) value, typically ranging from 100 to 400 decibels per meter (dB/m). Higher CAP values indicate a higher degree of fat accumulation in the liver.

Grading Liver Fibrosis and Steatosis

Grading Liver Fibrosis: Fibrosis staging helps to categorize the degree of liver scarring. Common staging systems include the METAVIR, Ishak, or the more simplified F0 to F4 system. For example:

  • F0: No fibrosis
  • F1: Mild fibrosis
  • F2: Moderate fibrosis
  • F3: Severe fibrosis
  • F4: Cirrhosis

Grading Liver Steatosis: For steatosis assessment, CAP values are often categorized as:

  • CAP < 248 dB/m: No or mild steatosis
  • CAP 248-268 dB/m: Moderate steatosis
  • CAP > 268 dB/m: Severe Steatosis

Conditions that Can Affect FibroScan Results

Several factors and conditions can potentially affect the accuracy and interpretation of FibroScan results. It's important to be aware of these factors, as they can influence the stiffness and fat content measurements of the liver. Conditions that can affect your FibroScan results include:

  • Recent Food or Alcohol Consumption: Eating a large or fatty meal just before the FibroScan procedure can temporarily increase liver stiffness, potentially leading to higher LSM values. Similarly, consuming alcohol before the test can also affect the results.
  • Inflammation and Acute Liver Injury: Conditions such as acute hepatitis, severe liver inflammation, or recent liver injury can lead to increased liver stiffness, potentially resulting in higher LSM values. These conditions may require interpretation in the context of the patient's clinical history.
  • Obesity: Excess body weight and obesity can sometimes lead to less accurate FibroScan results, particularly for liver fat measurement (CAP). Obesity may make it more challenging to obtain reliable readings.
  • Ascites: The presence of ascites, which is a buildup of fluid in the abdominal cavity often seen in patients with advanced liver disease, can affect the reliability of FibroScan results. The excess fluid can alter the liver's position and hinder the accuracy of the measurements.
  • Narrow Intercostal Spaces: FibroScan requires placing the probe between the ribs to access the liver. In individuals with very narrow intercostal spaces, the procedure may be more challenging and less accurate.
  • Metallic Implants: As stated earlier, the presence of metallic objects or implants within the body, such as pacemakers or surgical clips, can interfere with the FibroScan procedure or cause inaccurate results.
  • Operator Skill and Experience: The quality of FibroScan results can also depend on the operator's skill and experience in performing the procedure. An experienced technician or healthcare provider is more likely to obtain accurate readings.
  • Patient-specific Factors: Individual patient factors, such as body habitus, liver anatomy, and skin-to-liver capsule depth, can influence the ease and accuracy of FibroScan measurements.

It's important to communicate with your doctor and the technician performing the FibroScan about any relevant factors that might affect the results. They can take these factors into consideration when interpreting the data and making clinical recommendations. Additionally, doctors often consider FibroScan results alongside other clinical information to ensure accurate diagnosis and assessment of liver health.

How Much Does a FibroScan Cost?

The cost of a FibroScan can vary depending on several factors, including the location, the healthcare facility or clinic where the test is performed, and the specific healthcare system or insurance coverage. 

What to Expect after the FibroScan Test?

After the FibroScan, patients are advised to schedule a follow-up appointment with their doctor to review the results. Based on the results and any existing liver conditions, the doctor may recommend treatment options or lifestyle modifications. These recommendations could include changes in diet, exercise, medication, or interventions to manage liver disease.

If liver fibrosis or steatosis is detected, the doctor may establish a schedule for monitoring the patient’s liver health, which may involve regular FibroScan tests to track changes and assess the effectiveness of interventions.

It's essential to communicate openly with your doctor. If you have questions or concerns about your results or the recommended actions, don't hesitate to seek clarification and guidance.

Interpreting FibroScan results is a collaborative effort between patients and healthcare providers, and empowers individuals to take an active role in their liver health and make informed decisions to maintain or improve their well-being.