FibroScan (Liver Elastography)

What is FibroScan?

FibroScan is a specialized, FDA-cleared ultrasound-based technology that uses transient elastography to measure the stiffness and fat content of the liver. Liver stiffness is directly correlated with the degree of fibrosis (scarring), making FibroScan a reliable, non-invasive alternative to liver biopsy for assessing liver health.

The device provides two key measurements: a liver stiffness measurement (LSM), which indicates the level of fibrosis, and a Controlled Attenuation Parameter (CAP) score, which quantifies the amount of fat in the liver. Together, these results give Dr. Khan a comprehensive picture of your liver condition without the need for needles, sedation, or a hospital visit.

How Does FibroScan Work?

During a FibroScan examination, a small ultrasound-based probe is placed on the right side of your abdomen, over the area of the liver. The probe emits a painless, low-frequency vibration (shear wave) that travels through the liver tissue. Sensors in the probe then measure how quickly the shear wave passes through the liver.

The speed of the wave correlates directly with liver stiffness: the faster the wave travels, the stiffer (more fibrotic) the liver is. Healthy liver tissue is soft and elastic, so waves travel slowly. Scarred or fibrotic tissue is denser and stiffer, causing waves to travel faster. The device uses this information to calculate a precise stiffness score measured in kilopascals (kPa).

Simultaneously, the FibroScan measures the CAP score, which uses ultrasound attenuation to estimate the percentage of liver cells containing fat. This measurement is expressed in decibels per meter (dB/m) and is particularly useful for evaluating patients with suspected fatty liver disease.

Why is FibroScan Performed?

Dr. Khan may recommend a FibroScan for a variety of clinical reasons, including:

• Hepatitis B and C monitoring: Chronic viral hepatitis can cause progressive liver fibrosis over time. FibroScan allows Dr. Khan to monitor the degree of liver damage, guide treatment decisions, and track the liver's response to antiviral therapy.
• Fatty liver disease assessment (NAFLD/NASH): Non-alcoholic fatty liver disease is the most common liver condition in the United States. FibroScan can detect and quantify liver fat (using the CAP score) and assess whether fibrosis has developed, helping distinguish simple steatosis from the more serious non-alcoholic steatohepatitis (NASH).
• Alcohol-related liver disease: Chronic heavy alcohol use can lead to liver inflammation, fatty change, fibrosis, and ultimately cirrhosis. FibroScan helps assess the current level of liver damage in patients with a history of significant alcohol consumption.
• Cirrhosis staging: For patients with known or suspected cirrhosis, FibroScan provides an objective measurement of liver stiffness that can help stage the severity of the disease and guide management decisions.
• Treatment monitoring: FibroScan can be repeated over time to track changes in liver stiffness and fat content, allowing Dr. Khan to assess whether treatments, lifestyle changes, or dietary modifications are having a positive effect on liver health.

What to Expect

A FibroScan is one of the simplest and most comfortable diagnostic procedures available. The entire test is performed in the office and typically takes only 10 to 15 minutes. Here is what you can expect:

• You will lie comfortably on your back with your right arm raised above your head to expose the right side of your abdomen.
• Dr. Khan or a trained technician will apply a small amount of ultrasound gel to the skin over your liver area.
• The FibroScan probe is placed on the skin and several measurements are taken. You may feel a gentle tapping or vibration sensation, which is painless.
• The device captures 10 or more valid measurements to ensure accuracy, and the results are available immediately.

No sedation, anesthesia, or recovery time is needed. You can drive yourself to and from the appointment and resume all normal activities immediately afterward.

Understanding Your Results

FibroScan provides two numerical scores that Dr. Khan will review and explain to you:

Liver Stiffness Measurement (Fibrosis Score)

The liver stiffness result is measured in kilopascals (kPa) and corresponds to the METAVIR fibrosis scale, which ranges from F0 to F4:

• F0 – No fibrosis: Normal, healthy liver with no scarring (typically less than 5.5 kPa).
• F1 – Mild fibrosis: Minimal scarring is present, but liver function remains normal (approximately 5.5–7.0 kPa).
• F2 – Moderate fibrosis: More significant scarring is present, indicating progressive liver damage (approximately 7.0–9.5 kPa).
• F3 – Severe fibrosis: Extensive scarring that is approaching cirrhosis (approximately 9.5–12.5 kPa).
• F4 – Cirrhosis: Advanced scarring of the liver, indicating cirrhosis (typically greater than 12.5 kPa).

Note: Exact kPa thresholds may vary depending on the underlying liver condition. Dr. Khan will interpret your results in the context of your specific medical history.

CAP Score (Liver Fat)

The Controlled Attenuation Parameter (CAP) measures liver fat content in decibels per meter (dB/m):

• Less than 238 dB/m: Normal (less than 10% liver fat)
• 238–260 dB/m: Mild steatosis (11–33% liver fat)
• 260–290 dB/m: Moderate steatosis (34–66% liver fat)
• Greater than 290 dB/m: Severe steatosis (more than 67% liver fat)

Benefits vs. Liver Biopsy

Traditionally, liver biopsy has been the gold standard for assessing liver fibrosis and fat content. However, FibroScan offers significant advantages that make it the preferred initial assessment tool in many clinical scenarios:

• Non-invasive: No needles, incisions, or tissue samples are required — the test is performed entirely through the skin using ultrasound technology.
• Painless: The procedure is comfortable with no pain, compared to the discomfort and soreness commonly associated with liver biopsy.
• Immediate results: FibroScan results are available within minutes, whereas biopsy results may take one to two weeks.
• Easily repeatable: Because FibroScan is non-invasive and risk-free, it can be repeated as often as needed to monitor disease progression or treatment response over time.
• No recovery time: You can return to all normal activities immediately, while liver biopsy typically requires several hours of observation and a day or more of restricted activity.
• No risk of complications: Liver biopsy carries a small risk of bleeding, infection, and organ injury. FibroScan has no known complications or side effects.

Who Should Get a FibroScan?

Dr. Khan may recommend FibroScan for patients who fall into one or more of the following categories:

• Chronic hepatitis B or C: Patients with chronic viral hepatitis should have regular liver fibrosis assessment to guide treatment decisions and monitor disease progression.
• Non-alcoholic fatty liver disease (NAFLD) or NASH: Patients diagnosed with or suspected of having fatty liver disease benefit from FibroScan to determine whether fibrosis has developed.
• Heavy alcohol use: Individuals with a history of significant alcohol consumption should be evaluated for alcohol-related liver damage.
• Diabetes with liver risk: Type 2 diabetes is a major risk factor for NAFLD and NASH. Patients with diabetes and abnormal liver enzymes or imaging findings may benefit from FibroScan assessment.
• Obesity: Obesity is closely associated with fatty liver disease and metabolic syndrome, both of which increase the risk of liver fibrosis.
• Abnormal liver blood tests: Elevated liver enzymes (ALT, AST) or other abnormal liver function tests may prompt Dr. Khan to recommend a FibroScan to assess the degree of underlying liver damage.
• Known liver disease requiring monitoring: Patients with any chronic liver condition can benefit from periodic FibroScan examinations to track changes over time.

Preparation

FibroScan requires minimal preparation. To ensure the most accurate results, please follow these simple guidelines:

• Fast for 2 to 3 hours: Do not eat or drink anything (other than water and necessary medications) for at least 2 to 3 hours before your appointment. Eating can temporarily affect liver stiffness measurements.
• Avoid alcohol for 24 hours: Do not consume any alcoholic beverages for at least 24 hours before the test, as alcohol can temporarily increase liver stiffness and affect the accuracy of your results.
• Wear comfortable clothing: You will need to expose the right side of your abdomen, so loose-fitting clothing or a shirt that can be easily lifted is recommended.

If you have questions about your liver health or would like to schedule a FibroScan, contact GastroCares to arrange a consultation with Dr. Khan.