Liver disorders can vary from simple (uncomplicated) elevations in liver enzymes to advanced forms of cirrhosis [end stage liver disease]. Viral hepatitis (hepatitis B or C), alcoholic liver disease, and non-alcoholic fatty liver disease (NAFLD) are among the most common liver diseases seen in the outpatient setting. Laboratory testing including serological (antibody) tests play an important part in evaluation of liver patients. Ultrasound and cross sectional imaging (CT or MRI) are also useful in assessing for complications of chronic liver disorders. For nearly a century liver biopsy has been used as an important tool in providing us information about the progression of liver disease and diagnosis of cirrhosis. As physicians, our objective is to interfere with the progression of liver disease from simple steatosis (fat accumulation) to inflammation to early fibrosis (scarring) and eventual cirrhosis and liver failure. However until recently, the only real means of assessing disease activity was a liver biopsy, with its associated risks and costs. However with the approval of the Fibroscan by the FDA in 2013, physicians now have noninvasive tool for assessment of liver disease.
Fibroscan is a revolutionary diagnostic modality that can assess the elasticity of the liver by bouncing shear (sound) waves across the skin overlying the liver. Fibroscan measures the velocity of these waves as they bounce off the liver. The velocity of the shear wave correlates with the stiffness of the organ which reflects the degree of scarring (fibrosis) in the underlying liver. The faster the wave travels the stiffer the organ. Thus a liver which has poor elasticity or sponginess tends to be firm (similar to a rock) and cirrhotic (with heavy scarring). Fibroscan is a non-invasive, painless, inexpensive and rapid procedure that correlates well with findings of a liver biopsy in assessing for liver fibrosis (scarring). Thus it has revolutionized the field of hepatology and provided patients an alternative to having a liver biopsy to determine the progression of their disease state. Since the Fibroscan examination is brief and painless, it can easily be repeated on an annual basis to assess for liver fibrosis. Hence it provides the physician an enhanced means of following the patient’s response to therapy or progression of disease.
Due to its ease of use, a larger proportion of patients with liver disease are being assessed for fibrosis, than previously with liver biopsies. Most patients that have chronic viral or alcoholic hepatitis or fatty liver disease have never had a liver biopsy. This is due to physician reluctance, patient fear and cost of the procedure. However all of these patients can now readily be scanned with Fiboscan to determine whether they are showing signs of early fibrosis and need closer medical attention and treatment. Being available in Europe and Asia, Fibroscan has instantly become a ‘routine’ procedure in the evaluation of chronic liver disorders in the U.S.
Fibroscan Examination –
- The patient lies down on a stretcher looing up toward the ceiling.
- The technician will apply a small amount of water based gel to right upper abdomen and place the probe with a slight pressure over the liver.
- Ten consecutive measurements are made at the same location. The device will measure the state of the liver globally, as opposed to a biopsy where only a very small sample is measured.
- The test takes about 10 minutes, and the quantitative results are delivered immediately. The result is a number between 1.5 and 75 kPa (measure of resistance).
- Fibroscan scoring is than correlated with the biopsy grading system F(0-4)