From the Guidelines
You should get a FibroScan if your FIB-4 score is indeterminate (1.3-2.67) or high (>2.67), as it can help confirm the presence of advanced liver fibrosis. This recommendation is based on the most recent and highest quality study, which suggests that FibroScan is a useful tool for risk stratification in patients with non-alcoholic fatty liver disease (NAFLD) 1. The FIB-4 score is a non-invasive test that can be used to assess the risk of advanced liver fibrosis, and a score of <1.3 can reliably exclude advanced fibrosis, while a score of >2.67 indicates a high risk of advanced fibrosis.
Some key points to consider when interpreting FIB-4 scores include:
- A score of <1.3 can reliably exclude advanced fibrosis, with a negative predictive value of ≥90% 1
- A score of >2.67 indicates a high risk of advanced fibrosis, with a positive predictive value of 60-80% 1
- Patients with indeterminate scores (1.3-2.67) may benefit from further evaluation with FibroScan or other non-invasive tests 1
It's also important to note that FibroScan is a non-invasive test that uses ultrasound technology to measure liver stiffness, which correlates with the degree of fibrosis. The test is quick, painless, and provides immediate results that can help guide treatment decisions. However, certain factors like obesity, ascites, or acute inflammation can affect accuracy, so your doctor will consider your complete clinical picture when interpreting results 1.
In terms of the timing of the test, patients with a high FIB-4 score (>2.67) or an indeterminate score (1.3-2.67) may benefit from a FibroScan, while those with a low FIB-4 score (<1.3) may not need further evaluation. Additionally, patients with a liver stiffness measurement (LSM) of <8.0 kPa are considered low risk for clinically significant fibrosis, while those with an LSM of >12.0 kPa are considered high risk and may benefit from referral to a hepatologist 1.
Overall, the decision to get a FibroScan should be based on a comprehensive evaluation of your individual risk factors and medical history, and should be made in consultation with your healthcare provider.
From the Research
When to Get a FibroScan
- A FibroScan is a non-invasive test used to assess liver fibrosis and steatosis, and it can be considered for patients with chronic liver disease, including non-alcoholic fatty liver disease (NAFLD) 2, 3, 4, 5, 6.
- The test is particularly useful for patients who are at risk of advanced fibrosis or cirrhosis, as it can provide an accurate estimate of liver fibrosis stage without the need for a liver biopsy 3, 4.
- FibroScan can also be used to monitor the progression of liver disease and the effectiveness of treatment 3, 5.
Indications for FibroScan
- Patients with NAFLD who are at risk of advanced fibrosis or cirrhosis, such as those with elevated liver enzymes, insulin resistance, or a family history of liver disease 3, 4.
- Patients with chronic hepatitis C or B, or other chronic liver diseases, who require monitoring of liver fibrosis progression 2, 6.
- Patients who are being considered for liver biopsy, but may not be good candidates for the procedure due to medical reasons or personal preferences 2, 6.
Factors Affecting FibroScan Measurements
- Inflammation, congestion, and cholestasis can affect liver stiffness measurements (LSM) obtained by FibroScan, in addition to fibrosis 5.
- Body mass index (BMI) can affect controlled attenuation parameter (CAP) values, which are used to estimate liver steatosis 5.
- The type of probe used (M or XL) can also affect LSM and CAP values, although the diagnostic accuracy of the two probes is similar 5.