From the Guidelines
FibroScan is the preferred non-invasive test for evaluating liver stiffness and assessing the severity of liver fibrosis/cirrhosis, particularly in patients with known liver disease, as it is the most validated and widely available technique in liver clinics. According to the European Association for Haemophilia and Allied Disorders, European Haemophilia Consortium, ISTH, and World Federation of Hemophilia guidelines, published in the Journal of Thrombosis and Haemostasis in 2024 1, FibroScan is recommended as a second-line approach after stratification by inexpensive routine tests like Fibrosis-4 (FIB-4).
The procedure involves measuring liver stiffness using transient elastography (TE), which is a painless and non-invasive method that provides immediate results. The results are measured in kilopascals (kPa), with higher readings indicating more advanced fibrosis. A FibroScan value of ≥15 kPa is highly suggestive of compensated advanced chronic liver disease (cACLD), whereas a value between 10 and 15 belongs to the gray zone where platelets can help.
Key points to consider when using FibroScan include:
- A FibroScan value of <10 kPa can rule out cACLD
- A FibroScan value of <15 kPa together with a platelet count of >150 000 can help rule out cACLD
- The test should be performed after a fasting period of at least 3 hours for optimal results
- FibroScan is an excellent alternative to liver biopsy, as it is non-invasive and provides immediate results, reducing the risks associated with invasive procedures like bleeding or infection.
From the Research
Fiberscan Overview
- FibroScan is a non-invasive method for assessing hepatic fibrosis in patients with chronic liver disease by measuring liver stiffness 2.
- It can be easily performed at the bedside or in the outpatients clinic with immediate results and good reproducibility 2.
- FibroScan is validated for the diagnosis of significant fibrosis and cirrhosis in chronic hepatitis C, recurrence of hepatitis C after liver transplantation, co-infections in HIV-HCV patients, and chronic cholestatic diseases 2.
Diagnostic Accuracy
- The diagnostic accuracy of FibroScan is high, with an area under the receiver operating curve (AUROC) of 0.89 and 0.90 for predicting cirrhosis 3.
- FibroScan has a moderate accuracy in predicting significant fibrosis, with an AUROC of 0.72-0.78 3.
- The diagnostic accuracy of FibroScan is comparable to that of FibroTouch, another non-invasive diagnostic tool for liver fibrosis 4.
Clinical Utility
- FibroScan is a valuable tool for early detection of cirrhosis and evaluation of portal hypertension, and may have prognostic value as well 2.
- FibroScan can be used for the follow-up of patients with and without treatment, and for the screening of patients at risk of liver disease 2.
- The clinical utility of FibroScan is supported by its ability to provide a reliable and safe non-invasive means of assessing disease severity in chronic liver disease of varying etiology 5.