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
info@liverscan.ca

Tel: 416-268-0150

Fax: 647-494-3243

www.liverscan.ca

 

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%.

 

RECOMMENDATIONS:

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.

 

6 Years for a complete diagnosis! This HAS to change!

My daughter was first told she had NASH in 2008 at age 11, now I know that there is NO way that this pediatrician could have known if this was NASH or NAFLD from the ultrasound and blood test results but he was the first to say no reason to do a biopsy or any other tests. My daughter would just have to exercise and eat better.  No other advice was given, no direction as to what it means to eat better with liver disease.

As the years went on we had all kinds of doctors discount my daughters illness, I asked for referrals to a hepatologist and we were sent to a gastroentologist who also shrugged their shoulders and said no point doing any additional testing. My child has been through hell for the last 6 years with extreme vertigo, broken bones that wouldn’t heal, extreme menstrual bleeding and more colds and flus than I can count. Nothing is simple for my daughter any type of trauma to the body in illness or injury takes her down for weeks, never just days like the rest of us. 4 months for a broken toe, that the rest of us would see heal in 6 weeks!  No doctor has ever said hmm well maybe the issues in her liver are causing other things not to work as well in the body.

The liver controls our immunity, the liver controls our metabolism, our eyes, our toxins to the skin causing rashes. When your liver is compromised then there are serious impacts on your day to day life.  But no doctor has ever figured this out for my daughter.

So last week my daughter had a new non invasive test in Toronto called the fibroscan.  This does not need a referral and we were able to book a quick appointment If we had not had this test done we would still be in the dark as to the actual condition of my daughters liver.  The test was easy and fast and no negative impacts on my daughter. The results say that she has mild stage 1 steatosis and mild stage 1 fibrosis. The most important part is clearly fibrosis. This means that she has scar tissue in her liver and it means that the disease is more serious that any doctor has ever considered.

The good news is we now have a baseline to work from and we will focus everything on getting that fibrosis reversed. However, what we will never know is was the disease worse 6 years ago? Has it improved or gotten worse?

If any doctor in the last 6 years had considered the full picture for my daughter ,maybe we could have done this sooner. but nope she will be just fine they said…. Fibrosis folks …not just fine.

Demand that your doctor get the official details of your disease with a biopsy and/or a fibroscan! DO not let them say you will be just fine! IF we did not take this seriously my daughter could be on the transplant list by now. If not for my supporting those with this disease and not letting it go….this could be a much worse story!