FibroScan is a simple, rapid, non-invasive, reliable and painless diagnostic tool for assessment of severity and staging of liver fibrosis in various chronic liver diseases (fatty liver disease, hepatitis B and hepatitis C). It was introduced by Echosens in Paris, France in the European market in 2003, China in 2008, Canada in 2009, Brazil in 2010 and Japan in 2011 and US in 2013. It is now available in 70+ countries. It is used to measure tissue elastography (tissue stiffness) with the help of low-frequency ultrasound. Liver biopsy, which is an expensive, painful and invasive means for the evaluation of fibrosis and staging, has been used historically. However, FibroScan that is a non-invasive technique has become popular since its advent, as it carries less complications compared to biopsies and has emerged as an alternative to it.
Can you drink Water before a FibroScan?
FibroScan uses transient elastography technique and is a safe technique. The patient is asked to fast for 2-3 hours before the procedure as there is a greater chance of increased liver stiffness due to blood flow post-prandially. The patient is asked to avoid even water 3 hours before the procedure, thus a patient cannot drink water before FibroScan. However, a patient can take small sips of water if he/she is too thirsty, but not in large amounts.
FibroScan does not require any kind of anesthesia and it is a painless technique and takes only about 5-10 minutes to complete. Patient is asked to lie on supine position and rest their right hand above and behind the head and a water based gel is applied on the exposed right abdominal area. An ultrasound transducer probe is placed between the intercostal spaces on the right liver lobe. The velocity of this propagated elastic shear wave is measured through a pulse-echo ultrasound, which directly correlates to tissue stiffness and liver fibrosis. The patient might feel mild vibration due to ultrasound waves. A patient can get the results soon after the test and there is no delay in receiving results.
Limitations Of FibroScan
FibroScan that utilizes transient elastography has its own limitations. There are greater chances of failure rates and unreliable results in overweight/obese patients, children, thin patients in which different probes are used than standard probes. Liver stiffness values also differ in the cases of alanine aminotransferase elevation and acute liver inflammation. Other limitations include age, BMI, metabolic syndrome, sinusoidal congestion, steatosis and extra hepatic cholestasis. Like any other ultrasound based technique, it is highly dependent on operator.
What Is FibroScan Used For?
FibroScan is used to measure liver fibrosis and cirrhosis caused due to various liver diseases. The various liver diseases include hepatitis B, hepatitis C, alcohol, non-alcoholic fatty liver disease, certain drugs and toxins, trauma and biliary obstruction. Liver fibrosis is excessive liver scarring due to progressive liver inflammation and liver cell death in chronic liver diseases. Liver fibrosis occurs when liver tries to repair its damaged cells through deposition of new collagen fibers. This deposition of repaired tissue results in scarred tissue or fibrous tissue formation. This exaggerated wound healing response interferes with normal liver function.
Liver fibrosis severity is classified in different stages that helps determine the degree of damage afflicted to the liver. The staging of liver fibrosis is imperative to appropriate treatment of liver disease patients. Staging is also useful in addressing patient’s response to different treatment modalities.
The fibrosis staging consists of five stages fibrosis scoring system ranging from F0 to F4. F0 includes no evidence of fibrosis, F1 stage includes portal fibrosis without septa formation, F2 stage has portal fibrosis along with few septa formation, F3 staging consists of various septa without any cirrhosis, and F4 staging consists of liver fibrosis. F3 and F4 are considered the most advanced stages of liver fibrosis.