FibroScan® - Liver Screening

What is a FibroScan® -  Liver Screening? 

FibroScan® is a proprietary name for a device that uses transient elastography (TE) technology to assess liver elasticity and stiffness/density. Essentially, this is an elastographic method that can be described as a more advanced version of palpation. However, unlike palpation, where physicians rely on their sense of touch to assess the hardness of the observed organ or detect lumps, elastography uses a device that generates a mechanical wave/tapping on the surface of the skin. This wave is transmitted through the liver parenchyma, and the density/stiffness of the liver tissue is calculated based on the speed of wave propagation, allowing the results to be expressed in specific numerical data.

By measuring liver elasticity and stiffness, FibroScan® assesses the degree of damage to the liver parenchyma. Additionally, FibroScan® can measure the fat content in the liver, i.e., the degree of steatosis, using a function called the Controlled Attenuation Parameter (CAP).

Why is a FibroScan® so important? 

FibroScan® is considered the gold standard among non-invasive elastographic methods because it can very accurately, and entirely painlessly, determine liver stiffness and elasticity. This allows for the assessment of liver damage and the measurement of fat accumulation in the liver parenchyma. Today, for a large number of patients, FibroScan® is an excellent alternative to the invasive needle liver biopsy, which was the only method available until the early 21st century for assessing liver damage and treatment efficacy, despite its associated risks and complications.

With the help of FibroScan®, physicians can complete the diagnostic puzzle of liver diseases and gain a detailed and clear understanding of the liver's condition, which is crucial for determining appropriate therapy and, thus, a critical factor in timely and effective treatment of liver diseases. Due to its high accuracy in determining the degree of liver fat infiltration and damage, FibroScan® is an exceptionally valuable tool for early detection (even before symptoms appear) and monitoring the progression of various liver diseases, including steatosis (fatty liver), alcoholic liver disease, chronic viral hepatitis B and C infections, autoimmune liver diseases, and metabolic liver diseases. By tracking the progression of liver damage in these conditions, it is possible to detect an increased risk of developing hepatocellular carcinoma (liver cell cancer) early and plan patient monitoring accordingly. Similarly, this method allows for the monitoring of the (positive) effects of treatment for specific liver diseases.

As fatty liver disease is considered a disease of the 21st century and a risk factor for liver cancer development, according to modern research, the precision of FibroScan® as a non-invasive method in the early diagnosis of fatty liver is undoubtedly a significant advantage.

Who is FibroScan® recommended for?

Most liver diseases do not present specific symptoms, especially in the early stages. Liver enlargement, often associated with sudden changes in the liver, may be linked to mild pain under the right ribcage, which is again nonspecific. However, liver diseases frequently alter laboratory liver function tests, raising suspicion of liver damage.

In general, a FibroScan® Liver Screening is recommended for patients who:

• have been diagnosed with fatty liver (hepatic steatosis) via ultrasound
• have elevated liver transaminases (ALT, AST, GGT) and increased bilirubin levels in the blood
• have elevated blood lipids (triglycerides, cholesterol)
• have diabetes
• frequently consume alcohol or have a known history of liver damage

More specifically, FibroScan® is an essential part of diagnostic and therapeutic protocols for individuals suspected of having liver disease or for monitoring an already established condition, such as:

• non-alcoholic fatty liver disease (NAFLD)
• toxic liver damage
• alcoholic liver disease
• viral liver diseases (chronic hepatitis B and C infections)
• autoimmune liver diseases
• liver fibrosis
• liver cirrhosis

There are also less common diseases and conditions where FibroScan® plays a crucial role in assessing liver parenchyma status, such as celiac disease (one potential cause of hepatic steatosis), heart diseases leading to congestive hepatopathy, cystic fibrosis, and many other situations where measuring liver parenchyma density with FibroScan® provides additional value in diagnosis and treatment.

The etiology of the disease (cause of liver damage), along with laboratory and ultrasound findings, combined with FibroScan®, is crucial for accurate and precise interpretation of the numerical values measured by FibroScan®.

Are there any contraindications for a FibroScan® liver screening? 

This method is non-invasive and safe, and there are no absolute contraindications where its use is strictly prohibited.

However, there are so-called relative contraindications, situations in which FibroScan® should not be performed as it may not yield reliable results:

• Ascites (free fluid in the abdomen): Due to the nature of the method, accurate measurement is technically impossible in patients with free abdominal fluid.
• Severe obesity: When the distance between the skin and the liver capsule exceeds 35 mm, the device faces technical limitations for accurate measurement (this distance is assessed via ultrasound examination).

How is a FibroScan® liver screening performed? 

FibroScan® is based on the principle that damaged liver tissue is stiffer than healthy liver tissue.

During transient elastography (TE), known as FibroScan®, the physician places a probe on the surface of the skin that emits mechanical and ultrasonic waves, which the patient feels as light vibrations on the skin. The mechanical wave then travels through the liver, causing tissue displacements that are recorded via ultrasound. The FibroScan® device measures the speed at which the mechanical wave propagates through the liver, calculating its elasticity, or stiffness, which correlates with the degree of liver damage. The denser and stiffer the liver tissue, the faster the wave travels. Additionally, the device measures how much the liver tissue attenuates ultrasonic waves. In this case, the higher the fat percentage in the liver, the greater the attenuation of the ultrasonic waves. Ultimately, the FibroScan® device displays two key data points on the screen: liver stiffness (expressed in kPa) and steatosis quantification (expressed in dB/m).

What are the advantages of a FibroScan® liver screening? 

It is a non-invasive, completely painless, reliable, and safe method with no associated risks. The procedure is quick, lasting only about ten minutes, and can be repeated an unlimited number of times. A major advantage of FibroScan® is that it can often completely replace a liver biopsy, an invasive method that carries risks such as pain, infection, and bleeding. Additionally, measurements performed with FibroScan® encompass a volume of the liver that is 100 times larger than what can be covered by a liver biopsy, and the results are obtained immediately, in real-time. If necessary, results can be complemented with laboratory diagnostics. However, results should always be interpreted in conjunction with anamnesis, biochemical, and clinical parameters.

FibroScan® significantly contributes to defining the state of the liver, with its greatest advantage being the non-invasive detection of significant liver changes, as well as the ability to rule out significant liver diseases.

Want to check your liver health? Don’t wait—early detection, before any symptoms appear, can help you effectively treat liver diseases and prevent serious complications! Contact our Centre for Gastroenterology at email info@stcatherine.com or by phone +385 1 2867 400, and entrust your care to our team of experts!