From the Guidelines
FibroScan interpretation involves analyzing liver stiffness measurements, with a low cutoff of 8.0 kPa to exclude clinically significant fibrosis and a high cutoff of 12.0 kPa to indicate likely clinically significant fibrosis, as recommended by the most recent guidelines 1.
Key Considerations for Interpretation
When interpreting FibroScan results, it is essential to consider the following factors:
- Liver stiffness measurements (LSM) are measured in kilopascals (kPa) and reflect the risk for clinically significant fibrosis.
- A low cutoff of 8.0 kPa can be used to exclude clinically significant fibrosis, with a high negative predictive value 1.
- A high cutoff of 12.0 kPa indicates likely clinically significant fibrosis, with positive predictive values of 76% and 88% in patients seen in diabetes and hepatology clinic populations, respectively 1.
- Patients with LSM results between 8.0-12.0 kPa are considered indeterminate and may require further testing, such as liver biopsy or magnetic resonance elastography (MRE) 1.
- Factors like obesity, ascites, acute inflammation, and recent food intake can affect the accuracy of FibroScan results 1.
Clinical Application
In clinical practice, FibroScan results should be interpreted alongside clinical findings, laboratory tests, and patient history. Regular monitoring with FibroScan can help track disease progression and treatment response in chronic liver conditions. If FibroScan suggests advanced fibrosis or cirrhosis, additional testing like liver biopsy may be warranted for confirmation. The most recent guidelines recommend using a simplified rounded value of 8.0 kPa as the low cutoff to exclude clinically significant fibrosis and 12.0 kPa as the upper cutoff to indicate likely clinically significant fibrosis 1.
Additional Testing
For patients with indeterminate or high-risk LSM results, additional testing such as liver biopsy, MRE, or proprietary blood tests may be necessary to confirm the diagnosis and guide management decisions 1.
Limitations and Future Directions
While FibroScan is a valuable non-invasive tool for assessing liver fibrosis, its accuracy can be affected by various factors, and further research is needed to refine its interpretation and application in clinical practice 1.
From the Research
Interpretation of FibroScan Results
The interpretation of FibroScan results is based on the liver stiffness measurement (LSM) values, which are expressed in kilopascals (kPa). The following are the general guidelines for interpreting FibroScan results:
- F0-F1 (no or mild fibrosis): LSM values < 7.5 kPa 2
- F2 (moderate fibrosis): LSM values between 7.5-9.5 kPa 2, 3
- F3 (severe fibrosis): LSM values between 9.5-14 kPa 2, 3
- F4 (cirrhosis): LSM values > 14 kPa 2, 3
Factors Affecting FibroScan Results
Several factors can affect the accuracy of FibroScan results, including:
- Liver inflammation: High levels of liver inflammation can lead to overestimation of fibrosis stage 4
- Steatosis: Fatty liver disease can affect the accuracy of FibroScan results, although the extent of this effect is not well established 3
- Alcoholic hepatitis: Acute alcoholic hepatitis can affect the accuracy of FibroScan results, although the extent of this effect is not well established 3
Clinical Applications of FibroScan
FibroScan has several clinical applications, including:
- Diagnosis of liver fibrosis: FibroScan can be used to diagnose liver fibrosis in patients with chronic viral hepatitis, alcoholic liver disease, and other liver conditions 5, 2, 3, 6
- Monitoring of liver fibrosis: FibroScan can be used to monitor the progression of liver fibrosis in patients with chronic liver disease 5, 3
- Prediction of portal hypertension: FibroScan can be used to predict the presence of portal hypertension in patients with cirrhosis 3