What is the interpretation of a FibroScan (Fibrosis Scan) result?

From the Guidelines

FibroScan interpretation should be based on the most recent and highest quality evidence, which recommends using a low cutoff of 8.0 kPa to exclude clinically significant fibrosis and a high cutoff of 12.0 kPa to indicate likely clinically significant fibrosis. According to the study by Kanwal et al. 1, a liver stiffness measurement (LSM) of <8.0 kPa can be considered low risk for clinically significant fibrosis, while a value of >12.0 kPa indicates that clinically significant fibrosis is likely.

Key Considerations for Interpretation

• The study by Kanwal et al. 1 provides the most recent and highest quality evidence for FibroScan interpretation, and its recommendations should be prioritized.
• The European Association for the Study of the Liver (EASL) guidelines 1 also support the use of LSM by transient elastography (TE) to rule out and diagnose advanced fibrosis and cirrhosis, with cut-offs of <8-10 kPa to rule out and >12-15 kPa to rule in.
• Another study 1 suggests using a FibroScan value of <10 kPa to rule out compensated advanced chronic liver disease (cACLD) and a value of ≥15 kPa to indicate cACLD.
• The EASL guidelines 1 also discuss the use of patented serum fibrosis biomarkers, such as FibroMeterTM and ELFTM, and the limitations of serum scores and TE, highlighting the need for combination strategies to improve diagnostic accuracy.

Clinical Application

• FibroScan results should be integrated with other clinical findings, including patient history, laboratory results, and risk factors, to provide a comprehensive assessment of liver disease severity.
• Factors like recent food intake, inflammation, and obesity can affect FibroScan readings, and results should be interpreted in the context of these potential limitations.
• If results are borderline or inconsistent with clinical presentation, additional testing, such as liver biopsy, may be warranted to confirm the diagnosis and guide management.

From the Research

Fibroscan Interpretation

Fibroscan is a non-invasive medical device that measures liver stiffness, which is a reliable method for diagnosing significant fibrosis and cirrhosis in patients with chronic liver disease 2. The liver stiffness measurement by FibroScan has been shown to have good diagnostic performance for significant fibrosis 2.

Liver Stiffness Measurement

Liver stiffness values below 6 kPa are considered normal and exclude ongoing liver disease, while values of 8 and 12.5 kPa represent generally accepted cut-off values for F3 and F4 fibrosis 3. However, liver stiffness can be influenced by various factors such as hepatic infiltration with tumor cells, inflammatory cells, or amyloidosis, and should always be interpreted in the context of clinical, imaging, and laboratory findings 3.

Probe Selection

The choice of probe in FibroScan is important, as the M and XL probes give significantly different results 4. The M probe should be used when the skin-liver capsule distance is <25 mm, and the XL probe should be used when the skin-liver capsule distance is ≥25 mm 4. A practical algorithm using body mass index (BMI) and the FibroScan Automatic Probe Selection tool can help physicians accurately choose which probe to use in clinical practice 4.

Diagnostic Accuracy

Liver stiffness measurement by FibroScan has been shown to be accurate for the diagnosis of liver fibrosis in non-alcoholic fatty liver disease (NAFLD) 5, 6. The diagnostic accuracy of FibroScan is comparable to that of blood fibrosis tests, such as FibroMeter(V2G) 6. FibroScan and FibroMeter(V2G) can also be used to estimate the histological fibrosis stage and patient prognosis in NAFLD 6.

Factors Influencing Liver Stiffness

Liver stiffness can be influenced by various factors, including steatosis, inflammation, and fibrosis 5. Lifestyle modifications, such as weight loss and increased physical activity, can reduce liver stiffness and improve NAFLD severity 5. Repeat measurements of liver stiffness after 6-12 months can help to confirm the diagnosis and monitor the response to treatment 5.

• Key factors influencing liver stiffness:
  • Steatosis
  • Inflammation
  • Fibrosis
  • Hepatic infiltration with tumor cells, inflammatory cells, or amyloidosis
  • Venous pressure
  • Mechanic cholestasis
• Important considerations for FibroScan interpretation:
  • Choice of probe (M or XL)
  • Skin-liver capsule distance
  • Body mass index (BMI)
  • Clinical, imaging, and laboratory findings
  • Repeat measurements after 6-12 months to confirm diagnosis and monitor response to treatment 5