Fatty Liver Disease and Fibroscan Testing

As per the Canadian Liver Foundation:

FibroScan (FS) is a completely non-invasive diagnostic instrument to measure fibrosis (scarring of the liver) of the liver. FS uses an “elastic wave” (transient elastography) to measure hepatic stiffness which correlates with fibrosis. FS is based on the premise that as the liver becomes more fibrotic, the tissue density increases and the liver becomes less elastic. FS is easier to perform, safer and less expensive in comparison to a liver biopsy.  Measurements with the FS can be taken at multiple locations of the liver whereas a liver biopsy tissue sample is taken from one location in the liver.

Fibroscan is a new technology that assesses the stiffness of the liver. The stiffer your liver is, the more damaged it is by fibroids and dead liver cells.  I was very interested in this new testing method as my daughter has never been considered for a biopsy.  I also run a group on Facebook with almost 1200 members around the world. This is important as a new testing and monitoring tool for Fatty Liver Disease.

Biopsy is currently considered the gold standard in testing the condition of your liver. This is done with a needle that is inserted into the liver to take sample tissue out and analyze its condition.  The problem with this method is that you can’t test the entire liver. So if you are gathering samples and you don’t happen to hit an area where there is damaged tissue, the result will falsely indicate that you do not have liver damage. Blood testing also does not provide consistent reliable results. I have members in my group that are in the more advanced stages of the disease who receive clean blood tests. I do not understand why that happens but as of 2014 I do not see either of these as a complete picture of the condition of your liver.

The fibroscan machine looks very much like a standard ultrasound. There are 2 probes that are positioned on both sides and a computer screen in the centre that has 2 testing abilities.

The first test is looking for the fatty infiltration in your liver. They will use a probe with a short tip that captures the shear wave velocity. If the probe receives a quick response it has found damaged liver tissue and been returned because the wave cannot continue past the damaged liver. If the probe takes a longer time to get the wave returned it means that your liver is healthier.  My daughter lay on her back and then had right arm up over her head. She was directed to turn towards her left side so that the technician had the best possible access to the liver. A spot of ultrasound gel was placed in 3 spots on her liver.  The technician took the probe and placed over the gel spot. My daughter described the sensation like it feels when a doctor is testing your reflexes.  Approximately 10 readings are done for this test.

There is an important consideration for this test. If there is a lot of belly fat around the liver this test may not be able to access the liver with this probe.   My daughter was able to get this probe to read her liver.

The second test is looking for Fibrosis and also dead tissue in the liver.  The probe is longer and it is able to read deeper within the liver. The same process is used and the results of both tests are sent to your hepatologist to be assessed.

The test results can provide you with a sense of the current status of your liver and if it’s done yearly you can monitor the progress of your recovery or additional damage that is occurring.

The Fibroscan technology was just released and approved in the United States in April 2013. The Toronto Fibroscan Clinic is receiving patients from the states as there are long waiting periods for the testing and the costs can be very high.  In Toronto you are not going to have a long wait to get the test done and you will be paying closer to 100 dollars versus 400 +. The Toronto Clinic can be reached via :

Sun Life Financial Centre

3300 Bloor Street West

Centre Tower, 11th Floor, Suite 3140

Toronto, ON  M8X 2X3

Tel: 416-268-0150

Fax: 647-494-3243



My daughter’s results came in with the following findings:

“ This FibroScan® suggests mild steatosis (grade 1) with mild fibrosis (stage 1). The prognosis is excellent. In patients with liver stiffness <6 kPa, the estimated 3-year risk of liver-related complications/mortality is ~3%.



1) Management of risk factors for fatty liver (e.g. weight loss, optimization of diabetes and dyslipidemia, and alcohol minimization).

2) Recommend a repeat scan in 1 to 2 years for disease monitoring. “


Robert P. Myers, MD, MSc, FRCPC

Hepatologist, Medical Director, Liver Scan Direct

Dr Myers sent the following note along with the results:

Hi Michelle. Attached is Megan’s report. The good news is that it suggests only mild, stage 1 fibrosis so the medium term prognosis is very good. I hope it reassures you two somewhat. Unfortunately the Fibroscan can’t differentiate NASH from non-NASH, but fibrosis is the most important outcome.


What this gives is a baseline, we do not know if when she started with this disease in 2008 it was better or worse than the stage 1 steatosis and mild fibrosis. Now we will refocus our efforts for clean eating and have this test redone in a year to see if this is reversible with diet and exercise or this will be permanent damage that my daughter will need to be aware of.

So with these comments and the results I want to stress that Fibroscan will not be the only test that you should rely on for answers about the current stage of your disease. You should note that this test cannot differentiate between NASH and NAFLD.

My recommendation is that when you receive a blood test that indicates higher values in the ALT and AST results have that confirmed via an ultrasound. The ultrasound will confirm if fatty cells are present in the liver based on the difference in the way they are displayed on the screen. The ultrasound can only tell you if they are fatty cells whether there is fibrosis, or NASH is not confirmed via ultrasound. If both the ultrasound and the blood tests confirm the presence of fat in your liver, then you can use the non-invasive Fibroscan test to determine if there is fibrosis. If there is further clarification required the Liver Biopsy can provide an analysis of a specific section of liver tissue.

Fibrosis indicates that there is Scar tissue in the liver. This occurs when the liver tries to repair damage in the liver and the repair process goes wrong. The more often this happens the more serious the liver disease will be. The damage can be caused by alcohol, prescription drugs and viruses.  When the liver is composed of more scar tissue than healthy tissue the disease has advanced to Cirrhosis.

I would advise patients with fatty liver disease to consider the Fibroscan an important part of monitoring the progress or improvement of the disease.



Guest Post – Connie Kaye – Routine Liver Function Tests

I have heard of fatty liver disease a million times in my medical transcription and editing work. The first time I ever really thought much about it was when the nurse called me after having routine blood work done at the free clinic. “Your liver tests seem to be a little elevated so we need you to come in and have more blood work.” I am sure the first thing most people do when they hear that something is not right is panic. I am no exception. Especially when they say, “Oh, don’t worry.” Any time you hear, “Don’t worry,” what is the first thing you do?! Panic button!! I had to literally force myself to calm down. Then I remembered a little about fatty liver from reports I had transcribed and did a little research. It did not seem so bad at first. The further down I dug, the more I realized how little I knew about how complicated fatty liver disease can be.

In my own case, I was feeling extremely fatigued when I first went in for my exam, exhausted in fact, and I had been having problems with my kidneys and thyroid. After doing my usual CBC, urine and thyroid tests and adjusting my thyroid and taking care of the urinary tract infections, the doc referred me to a urologist and nephrologist. Nothing “serious” was found. I even had a cystoscopy and ultrasound of just my kidneys. The only thing they found was a urinary stricture, which he opened up during the procedure. I was placed on a low-dose preventative antibiotic for a year, and the nephrologist told me I needed to control my blood pressure.

At some point, a complete comprehensive panel found my liver function tests were elevated. By that time I was having pain under my ribs, urinary retention, and sick as all get out. My first thought was, “What does that mean?”

So today I am going to talk about routine liver function tests that you should be having, at every annual exam, as they are related to the liver. If more people had a comprehensive metabolic panel, liver disease would be caught much earlier. Many people have no symptoms of fatty liver, so it isn’t caught until it is found by accident, either by lab work, ultrasound, or MRI. Early diagnosis is key to reversal.

So you go to the doctor for a check up and a few things stand out. Maybe you weigh too much and your blood pressure is elevated. These are risk factors for liver disease. The doctor will take your history and see what other problems you may have or in your family history. Make sure you talk to the doctor about the lab work and insist on the comprehensive metabolic panel (CMP). These are the liver function tests that will initially alert your doctor if something may possibly be going on with your liver.

The ALT or alanine transaminase is all about metabolising protein. This test is specific to the liver, so when your liver is damaged these levels increase. It doesn’t tell you why your liver isn’t working. It may not be fatty liver. It may be medication you are taking. It is the first step in the process of a diagnosis and reversal.

AST or aspartate transaminase is all about metabolising alanine. When your liver is damaged or diseased it also increases.

ALP or alkaline phosphatase is an enzyme in the liver, bile ducts and bone. Elevation in this could mean liver damage or disease, such as a blockage in your bile duct or a bone disease.

Your liver has several proteins that protect your liver. One of these is albumin. If your albumin or total protein is too low, you may have a problem with damage or disease in your liver.

When your red blood cells break down, as normally happens, bilirubin is born. If your liver can not clean the bilirubin out, you become jaundiced and this may indicate liver damage or disease.

I am not going to give normals here because every lab is different and ranges may be different. I encourage you to get a copy of your blood test. In fact, get a copy of every test that you have ever had or will have, every procedure, and every note in your clinic chart. They will usually have the normal ranges for the labs right on them. If you have abnormalities in any of these tests, please talk to your doctor (if they have not already talked to you). Try not to panic but be diligent to get to the bottom of it. The doctor should try to rule out anything else that could be causing abnormalities. In my case I already knew I had high cholesterol, and I was on a statin. We had already reduced it to a low dose because I was getting muscle aches and cramps. When he saw my ALT was elevated he took me off the statin altogether and started me on something else that was safer for the liver. He also gave me some diet tips and exercise advice and set me up for some more tests. Until next time…. work on making your liver smile!


Tip: Your liver smiles when you avoid foods containing high fructose corn syrup.