From the Guidelines
A FibroScan is appropriate when evaluating liver fibrosis or steatosis in patients with chronic liver disease, particularly for those with risk factors such as viral hepatitis, alcoholic liver disease, or non-alcoholic fatty liver disease (NAFLD), as it provides a non-invasive and accurate assessment of liver fibrosis severity. According to the most recent guidelines 1, non-invasive fibrosis tests, including FibroScan, should be used for ruling out rather than diagnosing advanced fibrosis in low-prevalence populations. The test is particularly useful for initial assessment of fibrosis severity, monitoring disease progression, and evaluating treatment response.
Key Indications for FibroScan
- Evaluating liver fibrosis or steatosis in patients with chronic liver disease
- Initial assessment of fibrosis severity
- Monitoring disease progression
- Evaluating treatment response
- Before starting antiviral therapy for hepatitis
- When diagnosing cirrhosis
- For periodic monitoring of patients with known liver disease
Advantages of FibroScan
- Non-invasive
- Quick (taking only 5-10 minutes)
- No recovery time
- Allows for repeated measurements over time
- High degree of accuracy for assessment of advanced liver fibrosis, as shown in a study comparing liver biopsy, AAR, APRI, Fibroscan, and FIB-4 in patients with chronic hepatitis 1
Limitations of FibroScan
- May be less accurate in obese patients, those with ascites, or acute inflammation
- Results should be interpreted alongside clinical findings and other tests
- Not suitable for unselected general populations, but rather for patients at risk of advanced liver fibrosis, such as those with metabolic risk factors and/or harmful use of alcohol 1
Clinical Considerations
- FibroScan should be used in conjunction with other diagnostic tools, such as liver blood tests (e.g., ALT, AST, and platelet count) and clinical evaluation, to provide a comprehensive assessment of liver disease
- The automatic calculation and systematic reporting of simple non-invasive fibrosis tests, such as FIB-4, can improve risk stratification and linkage to care in primary care settings 1
From the Research
Appropriate Use of FibroScan
A FibroScan, also known as a liver stiffness measurement (LSM), is a non-invasive test used to assess liver fibrosis. The following are scenarios where a FibroScan is appropriate:
- In patients with chronic hepatitis B infection, FibroScan can predict the presence of significant liver fibrosis, potentially avoiding the need for a liver biopsy 2.
- For diagnosing significant fibrosis (> or = F2) and cirrhosis in patients with chronic liver disease, FibroScan has been shown to be a reliable method 3.
- In patients with non-alcoholic fatty liver disease (NAFLD), FibroScan can be used to detect advanced fibrosis, although its accuracy may be lower than other non-invasive tests such as the Hepascore 4.
- In patients with chronic viral hepatitis, FibroScan has high diagnostic accuracy for cirrhosis, but moderate accuracy for significant fibrosis 5.
Factors Affecting FibroScan Accuracy
The accuracy of FibroScan can be affected by various factors, including:
- Liver inflammation, which can lead to misdiagnosis of fibrosis stage 6.
- The presence of other liver diseases, such as non-alcoholic fatty liver disease (NAFLD) 4.
- The stage of liver fibrosis, with FibroScan being more accurate for cirrhosis than significant fibrosis 5.
Clinical Applications
FibroScan can be used in various clinical settings, including:
- Monitoring disease progression in patients with chronic liver disease.
- Assessing the effectiveness of treatment in patients with liver fibrosis.
- Identifying patients who may require a liver biopsy to confirm the diagnosis of liver fibrosis.
- Screening for liver fibrosis in high-risk populations, such as those with chronic hepatitis B or C infection.