What are the indications for Fibroscan (Fibrosis Scan) in patients with chronic liver diseases?

Indications for FibroScan in Chronic Liver Diseases

FibroScan (transient elastography) is primarily indicated for non-invasive assessment of liver fibrosis in patients with chronic liver diseases to guide treatment decisions, evaluate disease progression, and monitor for cirrhosis. 1

Primary Indications

Chronic Viral Hepatitis

• Chronic Hepatitis B (CHB):

  • To determine need for antiviral therapy by assessing significant fibrosis (≥F2)
  • To detect cirrhosis (F4) for appropriate surveillance
  • Optimal cutoff values: 7.2-8.8 kPa for significant fibrosis; 11.0-14.1 kPa for cirrhosis 1

• Chronic Hepatitis C (HCV):

  • Assessment of fibrosis stage to guide treatment decisions
  • Monitoring of fibrosis regression after successful antiviral therapy

Non-viral Liver Diseases

• Nonalcoholic Fatty Liver Disease (NAFLD):

  • Evaluation of fibrosis in patients with metabolic risk factors
  • FIB-4 screening (cutoff ≥1.30) followed by FibroScan (≥8 kPa) for patients requiring hepatology referral 1

• Alcohol-related Liver Disease (ALD):

  • Assessment of fibrosis severity
  • Monitoring of fibrosis progression/regression with abstinence

• Autoimmune Liver Diseases:

  • Primary Biliary Cholangitis (PBC)
  • Autoimmune Hepatitis (AIH)
  • Primary Sclerosing Cholangitis (PSC) 1, 2

Clinical Decision-Making Algorithm

1. Initial Assessment:

   • Use inexpensive serum biomarkers first (FIB-4, APRI)
   • If FIB-4 ≥1.30 or APRI >0.5, proceed to FibroScan 1

2. FibroScan Interpretation:

   • <10 kPa: Rules out compensated advanced chronic liver disease (cACLD)
   • 10-15 kPa: Gray zone (consider platelet count)
   • ≥15 kPa: Highly suggestive of cACLD
   • ≥15 kPa + platelets <150,000: Confirms cACLD 1

3. Post-Treatment Monitoring:

   • Patients with previous advanced fibrosis/cirrhosis require continued monitoring despite successful treatment 1

Special Populations

• Patients with Bleeding Disorders:

  • FibroScan recommended after stratification with FIB-4 or APRI
  • Particularly important in those previously exposed to HBV/HCV 1

• Patients with Metabolic Syndrome:

  • Even without viral hepatitis history, FibroScan indicated when FIB-4 ≥1.30 1

Advantages Over Other Methods

• More accurate than APRI or FIB-4 for diagnosing cirrhosis (AUROC 0.902 vs. 0.707) 1
• Non-invasive, rapid (5 minutes), and immediately available results 1
• High reproducibility with excellent patient acceptance 3
• Reduces need for liver biopsy in most patients 4

Limitations and Pitfalls

• Technical Limitations:

  • Requires ≥10 successful measurements
  • Success rate ≥60% and interquartile range <30% of median value
  • Unreliable in patients with ascites, obesity, or narrow intercostal spaces 1

• False Positives:

  • Acute hepatitis
  • Extrahepatic biliary tract obstruction
  • Elevated ALT levels can overestimate fibrosis 1

• False Negatives:

  • Macronodular cirrhosis
  • Inactive cirrhosis 5

Combining Methods for Improved Accuracy

• Sequential use of FibroScan after serum biomarkers improves diagnostic performance
• Combining FibroScan with FibroTest or ELF test can reduce need for liver biopsy by 61-65% 1
• Using both approaches (biological and physical) increases diagnostic accuracy 4

FibroScan has transformed the management of chronic liver diseases by providing a reliable non-invasive alternative to liver biopsy for fibrosis assessment, with particular strength in early detection of cirrhosis and significant fibrosis that guide critical treatment decisions.