FibroScan
Los Angeles | The New Painless Alternative to Liver Biopsy
FibroScan® is a new medical device in the United States - approved by the FDA - that provides a painless and reliable alternative to liver biopsy. Our office is the first in Los Angeles to offer this examination to patients with the FibroScan® 502 device.
Fibroscan uses "shear waves" to measure the elasticity of the liver using an improved technique called Vibration-Controlled Transient Elastography (VCTE™). As the shear wave passes through the liver, it is affected by the amount of scarring (fibrosis), and this is interpreted to give an accurate global assessment of the stage of fibrosis (fibrosis staging). The proper use of shear wave velocity analysis requires control of various physical parameters to ensure an accurate, reliable, and reproducible assessment of tissue stiffness, all novel features incorporated into the Fibroscan 502 Touch device. The stiffer the liver the more severe fibrosis.
Liver fibrosis is a condition of scarring and stiffness of the liver and is caused by a variety of medical conditions. The most advanced and feared form of scarring is called Liver Cirrhosis. Cirrhosis (end stage liver disease) can result from long term liver infections or long term liver toxins (including excessive alcohol, some medications) in which the healthy liver tissues are slowly replaced by scar tissues. Initially the scar tissue is fine and delicate and hard to detect but over time it becomes thicker and can start to strangle the liver. This can prevent the liver doing what its job: nutrient metabolism and elimination and can lead to an advanced (often irreversible) condition termed "liver failure".
Patient with liver failure usually need a transplant. Avoidance of cirrhosis by early detection of fibrosis has been a challenge for both patients and doctors, in part because clinical examination and blood tests can easily miss it. In addition, doctors and patients alike prefer to avoid liver biopsies because they are both expensive and can have complications (e.g. pain and/or bleeding).
However some patients surprise us and their disease can progress faster than we expected or don't return to clinic for fear of biopsy. In this way, valuable time can be lost.
The Fibroscan test of the liver is now routinely used in Europe and elsewhere and has offered a great opportunity to both replace biopsy but also to track responses to treatment in a way that biopsy could not be used.
Using the FibroScan® 502 device, our office can now routinely provide this test to all patients who have or had chronic conditions of the liver including those patients who previously underwent treatment.
Patients who live with viral hepatitis might not have any noticeable health problems for years. However, as the years progress, scarring in the liver can build up and slowly lead to liver failure. Once that stage is reached, the patient will need a liver transplant.
With the new FibroScan technology it is now easy to measure the health of the liver and see how much scarring the hepatitis virus has caused. Knowing the stage of fibrosis can help a patient decide if they need to start a treatment plan immediately.
FibroScan® tests can be repeated regularly (e.g. every 6-12 months) without any health risks, which can help us monitor the progression of a liver disease. In case you start a treatment (e.g. for Hepatitis C), or making lifestyle changes to mitigate the damage to your liver, we can tell you with a follow-up examination how successful the treatment/lifestyle change was.
FibroScan® uses a button shaped probe placed at the skin surface that gives out a series of mechanical pulses (gentle shock waves) that travel through the liver. The FibroScan® measures how quickly these waves travel through the liver and how quickly they bounce back. In other words, it is measuring the velocity of the shock wave. Velocity of the wave correlates with the stiffness of the liver which reflects the degree of fibrosis. The quicker the wave travels, the stiffer your liver is and the more scar tissue you have in your liver. The unit of resistance is measured in Kpa. In general, cirrhosis is a concern at a resistance of 12 kPa and higher.
The sooner you know the state of your liver, the sooner you can act to prevent irreversible liver damage. The FibroScan® test gives you a quick and easy way to get an accurate assessment of the state of your liver.
Here is a simple comparison of a liver biopsy and FibroScan®
|
Liver Biopsy |
FibroScan |
Results |
Days or weeks |
Immediate |
Outpatient hospitalization required |
Yes |
No |
Bed rest required |
Yes |
No |
Examined area |
Small sample (very tiny part of the liver) |
Large Sample |
Easy to repeat |
No |
Yes |
FDA Approved |
Yes |
Yes |
Can be used for enrollment in Hepatitis trials |
Yes |
Yes |
Risks |
Bleeding, |
None |
Painless |
No |
Yes |
Time away from work |
1 day minimum |
none |
Cost |
$$$$ |
