What is a FibroScan (Fibrosis Scan) of the liver?

FibroScan of the Liver: A Non-Invasive Tool for Assessing Liver Fibrosis

FibroScan (transient elastography) is a non-invasive medical device that measures liver stiffness to assess the degree of liver fibrosis without requiring a liver biopsy, providing immediate results with good reproducibility. 1

What is FibroScan?

FibroScan uses transient elastography technology to:

• Measure liver stiffness by sending a mechanical wave through the liver and measuring its velocity
• Quantify the amount of fibrosis present in the liver tissue
• Provide results in kilopascals (kPa), with higher values indicating greater liver stiffness and more advanced fibrosis
• Generate immediate results during an outpatient visit (takes approximately 5 minutes) 1, 2

Clinical Applications

FibroScan is clinically validated for:

• Assessing liver fibrosis stages in chronic liver diseases, including:

  • Chronic hepatitis B and C
  • Alcoholic liver disease
  • Non-alcoholic fatty liver disease (NAFLD)
  • Primary biliary cholangitis
  • Other chronic liver conditions 1

• Identifying advanced fibrosis and cirrhosis with high accuracy

  • Particularly useful for detecting compensated advanced chronic liver disease (cACLD) 1
  • Helps identify patients at risk of developing liver-related complications

Interpretation of Results

Liver stiffness measurements are interpreted as follows:

• <8 kPa: Generally indicates low risk of advanced fibrosis 3
• 8-12 kPa: Indeterminate risk zone, may require additional testing 3
• >12 kPa: Suggests high risk of advanced fibrosis 3
• ≥15 kPa: Highly suggestive of compensated advanced chronic liver disease 1

For hepatitis C patients, specific cutoffs have been established:

• 5.9 kPa: For significant fibrosis (≥F2)
• 9.8 kPa: For advanced fibrosis (≥F3)
• 15.5 kPa: For cirrhosis (F4) 4

Advantages Over Liver Biopsy

FibroScan offers several benefits compared to liver biopsy:

• Non-invasive with no risk of complications
• Painless procedure with high patient acceptability
• Can be performed repeatedly for monitoring disease progression
• Examines a larger portion of the liver than biopsy (100 times larger)
• Provides immediate results
• Good reproducibility 2, 5, 6

Limitations and Factors Affecting Results

Important considerations when interpreting FibroScan results:

• Technical failure occurs in approximately 5% of cases, primarily in obese patients 5

• Results can be affected by:

  • Active inflammation (elevated liver enzymes >100 U/L)
  • Congestion (heart failure)
  • Cholestasis
  • Recent food intake
  • Obesity (may require XL probe) 1, 7

• For reliable results:

  • At least 10 successful measurements are required
  • Success rate should be at least 60%
  • Interquartile range should be less than 30% of the median value 1

Clinical Integration in Practice

FibroScan is most effectively used:

• As part of a stepwise approach to fibrosis assessment
• Following initial risk stratification with simple blood tests (FIB-4, APRI)
• In combination with clinical assessment and laboratory findings
• For periodic monitoring of disease progression or regression 1, 3

For patients with NAFLD, the American Association for the Study of Liver Diseases recommends FibroScan as a clinically useful tool for identifying advanced fibrosis, particularly after initial screening with FIB-4 or other non-invasive fibrosis scores 1.

Conclusion

FibroScan represents a significant advancement in the non-invasive assessment of liver fibrosis, allowing clinicians to evaluate and monitor liver disease without the risks associated with liver biopsy. Its high accuracy in detecting advanced fibrosis and cirrhosis makes it an invaluable tool in modern hepatology practice.