FibroScan® Understanding The Results

FibroScan® Scoring Card - Understanding The Results

Nonalcoholic Steatohepatitis (NASH) and Non-alcoholic Fatty Liver Disease (NAFLD):
Current research & media articles available on this blog:
Watch videos, or review research in this current collection of articles 

FibroScan®, sometimes called transient elastometry (TE) is a  FDA approved non-invasive test to measure liver inflammation and fibrosis, (arguably) comparable to a liver biopsy, particularly in the higher end of the Metavir scale (Stages 3 and 4).

This noninvasive imaging study is used to measure liver stiffness in units measured as kilopascals (kPa). Normal is 5.0 kPa. Higher degrees of liver stiffness are associated with higher degrees of fibrosis.

What is Metavir Grading System?
Several grading systems are used to determine "liver biopsy" results. The Metavir grading system uses two standardized numbers: one called "grade" to indicate degree of inflammation  (tissue swelling and irritation) and the other called "stage" which indicates the degree of fibrosis (tissue scarring due to prolonged inflammation).

A 4-point scale is used in grading the degree of liver inflammation or histological activity:
  • A0= no inflammation
  • A1= mild inflammation
  • A2= moderate inflammation
  • A3= severe inflammation

A 5-point scale is used in grading the degree of liver fibrosis:

  • F0= no fibrosis
  • F1= minimal fibrosis
  • F2= fibrosis has occurred and spread inside the areas of the liver including blood vessels
  • F3= fibrosis is spreading and connecting to other liver areas that contain fibrosis
  • F4= cirrhosis or advance liver fibrosis
Fibroscan scoring card
Keeping this in mind, we can use the Fibroscan scoring card to convert Fibroscan results measured in (kPa) into the Metavir scale F1-F4.

On transient elastography, more than 7 kPa is considered significant fibrosis (stages F2 to F4), and more than 11 kPa indicates cirrhosis (stage F4)

Located on the bottom of the Fibroscan scoring card is Fibroscan results in (kPa) measurements 0-75, more accurately Fibroscan results range from 2.5 kPa to 75 kPa. Between 90–95% of healthy people without liver disease will have a liver scarring measurement less then 7.0 kPa (median is 5.3 kPa).

A person with chronic hepatitis C and a liver stiffness more then 14 kPa has approximately a 90% probability of having cirrhosis, while patients with liver stiffness more then 7 kPa have around an 85% probability of at least significant fibrosis.

However,  research has shown Fibroscan accuracy in assessing lower degrees of liver fibrosis (F1-F2) is not as reliable compared to diagnosing advanced fibrosis and cirrhosis (F3/F4)

Fibroscan Scoring Card
Click on image to enlarge

A fibroscan score of  8.2 in "hepatitis C"  is the same as fibrosis stage 1-2 or (F1- F2) as shown in the color coded scale.

A fibroscan of 12.2  in a patient with "alcoholic liver disease" is borderline cirrhosis or (F3) .

Additional Links
Results are measured using kiloPascal’s (or kPa) and range from 2 to 75.

The normal range for a FibroScan® is between 2 to 7 kPa. The average normal result is 5.3 kPa.

Your liver doctor will explain these results to find out how much scarring you have. Your result will vary based on what liver disease you have.

Scarring has 4 stages: • F0 means no scarring • F1 is mild fibrosis • F2 is moderate fibrosis • F3 is severe fibrosis • F4 is cirrhosis or advanced fibrosis

The following table shows the stages of fibrosis.

Download the FibroScan pamphlet, here.

In The News
Of Interest
Dec 29, 2017

Aug 8, 2017
The NAFLD fibrosis score, fibrosis 4 calculator, enhanced liver fibrosis test, and FibroTest can be used to identify patients with advanced fibrosis, and results associate with cardiovascular and liver-related mortality. Tilg writes that although transient elastography is the most common technique used to define fibrosis stage of patients with NAFLD, it has limitations in evaluation of the very obese population and inter-investigator reliability. Tilg states that magnetic resonance elastography is now the most accurate method to assess stage of fibrosis.

Aug 7, 2017
***Vibration-controlled transient elastography (VCTE), commonly delivered by the FibroScan device, is an option approved by the Food and Drug Administration for the noninvasive assessment of liver disease at the point of care.
Vibration-controlled transient elastography (VCTE) is the most commonly used imaging-based fibrosis assessment method in the United States...... The current technical review and guideline were developed to provide clinicians with evidence-based guidance on the specific role of VCTE in clinical practice, and addressed focused clinically relevant questions reviewed by the Technical Review Committee....

June 23, 2017
Managing Chronic Hepatitis C in the Primary Care Setting: Best Practices From Screening to Treatment
Listen to Mark Sulkowski, MD discuss HCV screening, diagnosis, noninvasive tests for assessing liver fibrosis and current treatment options for all HCV genotypes (1-6). Although this podcast and online CME is aimed at clinicians the use of clinical vignettes make it easy for patients to understand.

April 13, 2017
Researchers found 2D shear wave elastography had good to excellent efficiency for evaluating liver fibrosis in patients, particularly those with hepatitis B, according to a recently published study.

Chart showing Sample Fibroscan result with kPa=3.9 (Fibrosis Stage 1)

Chart showing Sample Fibroscan result with kPa = 49.6 (Fibrosis Stage 4)

Diffusion-weighted MRI and fibroscan vs. histopathology for assessment of liver fibrosis in chronic HCV patients: (Pilot study)

Liver stiffness measurement (fibroscan®)

Alimentary Pharmacology & Therapeutics

VIDEO: Echosens discusses future of Fibroscan with new biomarkers
November 16, 2018
In this exclusive video from The Liver Meeting 2018, Sven Henrichwark, CEO of Echosens, discusses the company’s Fibroscan technology and the potential to combine Fibroscan with new biomarkers and scoring systems.

7 recent reports on noninvasive fibrosis detection, staging
July 5, 2018
Recent studies of early liver fibrosis and advanced fibrosis or cirrhosis have analyzed several noninvasive methods to accurately detect fibrosis, stage fibrosis, and…

April 2018
Watch: Diagnosing liver disease with Fibroscan technology
Read - NASH Fibroscan Overview

1 comment:

  1. I had a Fibroscan done today at the VA with a score of 46.3, am I doomed for death soon?