What is a FibroScan (Fibrosis Scan)?

From the Guidelines

A FibroScan is a non-invasive medical test that measures liver stiffness to assess the degree of liver fibrosis or scarring without requiring a biopsy, and it is particularly useful for monitoring chronic liver conditions like hepatitis B and C, fatty liver disease, and alcoholic liver disease. The procedure uses a technology called transient elastography, which sends sound waves through the liver and measures how quickly they travel through the tissue. Stiffer liver tissue, indicating more fibrosis, causes sound waves to travel faster. During the test, a technician places a probe on the skin over the liver area while you lie on your back with your right arm raised. The procedure typically takes about 10-15 minutes, is painless, and requires no recovery time. You may need to fast for 2-3 hours before the test for optimal results, as meal ingestion can increase liver stiffness values, and a minimum of 3 hours fasting is recommended for a correct measurement and interpretation 1.

Some key points to consider when interpreting FibroScan results include:

• A FibroScan value of ≥15 kPa is highly suggestive of compensated advanced chronic liver disease (cACLD) 1
• A FibroScan value of <10 kPa can help rule out cACLD 1
• A FibroScan value between 10 and 15 kPa belongs to the gray zone, where platelets can help in the diagnosis 1
• FibroScan results may be less reliable in obese patients or those with ascites (fluid in the abdomen) 1
• The test is not reliable in patients with obesity or ascites, and an extra-large probe is available for obese patients to try to overcome some limitations 1

FibroScan is a valuable tool for assessing liver fibrosis, with a sensitivity and specificity of 70% and 84%, respectively, for diagnosing significant fibrosis (F2 or greater) and 87% and 91%, respectively, for diagnosing cirrhosis (F4) 1. However, it is essential to consider the limitations and potential influences on liver stiffness measurements, such as edema, inflammation, extrahepatic cholestasis, and passive congestion 1.

In clinical practice, FibroScan can be used to monitor disease progression and treatment effectiveness, and to identify patients at risk of developing liver-related complications, as recommended by recent guidelines 1. The use of FibroScan, in combination with other non-invasive tests, can help to reduce the need for liver biopsies and improve patient outcomes.

From the Research

What is a FibroScan

• A FibroScan is a non-invasive medical device used to assess liver fibrosis, which is the scarring of liver tissue that can lead to cirrhosis 2, 3, 4, 5, 6.
• The device uses transient elastography, a technique that combines ultrasound and low-frequency elastic waves to measure liver stiffness, which is directly related to elasticity 2.
• The FibroScan is based on one-dimensional (1-D) transient elastography and uses a shear elasticity probe to quantify liver fibrosis 2.
• The device is painless, rapid, and objective, making it a convenient alternative to liver biopsy for assessing liver fibrosis 2, 6.

How it Works

• The FibroScan measures liver stiffness by sending low-frequency elastic waves through the liver tissue 2.
• The velocity of these waves is directly related to the elasticity of the liver tissue, which is affected by the degree of fibrosis 2.
• The device provides a numerical value, known as the liver stiffness measurement (LSM), which can be used to assess the stage of liver fibrosis 3, 4, 5.

Clinical Applications

• The FibroScan has been used to assess liver fibrosis in various chronic liver diseases, including chronic hepatitis B and C, non-alcoholic fatty liver disease (NAFLD), alcoholic liver disease, primary biliary cirrhosis, and primary sclerosing cholangitis 3, 4, 5, 6.
• The device has also been used to predict patient outcomes, such as the development of hepatocellular carcinoma (HCC), portal hypertension, and postoperative complications in HCC patients 5.
• The FibroScan can be used to monitor disease progression and response to treatment, making it a valuable tool for managing chronic liver diseases 5, 6.