What is FibroScan?

The liver is the largest organ in the body and is considered the metabolic factory of the body. It is located in the upper right part of the abdominal cavity, beneath the diaphragm, and is responsible for the synthesis of many substances. Chronic liver diseases are one of today's significant health issues. In the advanced stages of chronic liver diseases, liver cells become damaged and swollen (ballooned). As the disease progresses, scar tissue forms in the liver, which is defined as fibrosis.

As fibrosis tissue increases, the liver cannot function properly, and its function deteriorates over time. In severe cases of fibrosis, conditions such as cirrhosis, portal hypertension, and liver failure can occur. Therefore, the accurate diagnosis of the fibrosis stage in chronic liver diseases is crucial for monitoring and treatment decisions. Liver biopsy, which is used to evaluate fibrosis, is an effective method. However, recent studies indicate that complications arising from biopsies, differences in interpretation among evaluators, and cases where biopsies need to be repeated due to inadequate samples create limitations for biopsies. To minimize issues arising from these factors, FibroScan, a reliable, reproducible, and non-invasive method for assessing fibrosis, has recently become one of the preferred methods.

What is FibroScan?

In chronic liver diseases, liver tissue hardens. FibroScan is a technological device that quantitatively measures the elasticity of soft tissues. With FibroScan, data is measured in kilopascals (kPa) and indicates the amount/stages of fibrosis in the liver. FibroScan examines a liver area that is at least 100 times larger than the tissue obtained by liver biopsy. Therefore, this method provides better visualization of the liver parenchyma. The FibroScan procedure protocol is as follows:

• FibroScan consists of a probe, an electronic system, and a control unit.
• The ultrasonic transducer in the probe sends low-frequency and wavelength (amplitude) vibrations of about 50 MHz to the liver.
• The elastic wave created progresses through the tissue.
• The speed of wave transmission is directly proportional to the elasticity of the tissue it passes through.
• As stiffness increases, the speed of wave propagation increases, and this speed is determined by a detector on the probe.
• The FibroScan procedure is painless, causes no discomfort, and takes 1-2 minutes.
• The person being measured is asked to lie on their back and place their right arm behind their head, making it easier to visualize the liver.

When is the FibroScan Test Recommended?

The FibroScan test (Transient Elastography) has two important applications: determining the degree of fibrosis in liver diseases and diagnosing liver disease. The FibroScan test may be recommended by a physician in the presence of certain chronic liver diseases. Some of these diseases include:

• Metabolic and Autoimmune Hepatitis Disease
• Genetic Disorders (such as Hemochromatosis and Wilson's Disease)
• Cirrhosis
• Hepatitis B
• Hepatitis C
• Alcoholic Liver Disease
• Non-alcoholic Steatohepatitis (NASH)
• Hepatocellular carcinoma

What are the Benefits of FibroScan (Liver Damage Measurement)?

The FibroScan method used to determine the stages of fibrosis is more beneficial than other methods. The advantages of the FibroScan method can be listed as follows:

• FibroScan applications are quick, inexpensive, and painless.
• It is an easy-to-apply and repeatable method.
• It is a non-invasive procedure.
• The procedure time is short (1-5 minutes).
• Results are available immediately, and reliability is assessed by both the physician and the device.
• FibroScan helps in selecting patients suitable for biopsy, thereby preventing unnecessary biopsies.

What to Consider Before the Test?

Patients should pay attention to the following preparations before going to the test:

• The patient must fast for at least 4-6 hours (no eating or drinking).
• Coffee and smoking should be avoided for one day before the test.
• To prevent tachycardia (palpitations), excessive effort should be avoided before the procedure. For example, using the elevator instead of stairs when going for the procedure.
• If possible, resting for about 10-20 minutes before the procedure is recommended.
• Comfortable clothing should be worn for easier visualization.

Frequently Asked Questions About FibroScan

Here are some frequently asked questions about FibroScan:

What is FibroScan? What is Liver FibroScan?

FibroScan is the name of a medical device that measures liver functions using advanced technology. It provides a quick and easy examination without any invasive procedures. FibroScan uses a technology called transient elastography to measure liver stiffness (elasticity).

When Does a Doctor Request a FibroScan Test?

FibroScan is requested by physicians in the presence or suspicion of the following diseases:

• Chronic liver disease
• Metabolic and autoimmune hepatitis
• Genetic diseases (such as hemochromatosis and Wilson's disease)
• Hepatitis B
• Hepatitis C
• Cirrhosis
• Alcoholic liver disease
• Non-alcoholic steatohepatitis (NASH)
• Presence and/or suspicion of hepatocellular carcinoma.

What Does the FibroScan Test Look for in the Body?

In liver diseases, tissue elasticity decreases and stiffens. FibroScan is used to measure liver health and determine the stage of liver disease. It helps identify whether fibrosis is present and its degree.

Does FibroScan Measure Liver Fat?

Not all FibroScan devices may have the CAP feature. Devices with the CAP feature measure the amount of fat in the liver with much greater accuracy than ultrasound. A CAP result above 300 db/m is considered an indicator of significant liver fat accumulation.

What is a Normal FibroScan Result?

The fibrosis score ranges from 2.5 to 75 kPa, reflecting normal liver elasticity. A low score in the test result indicates a healthy liver. The CAP score is measured in decibels (dB/m) per meter and corresponds to the degree of steatosis (S1, S2, and S3). The lower the FibroScan CAP score and steatosis degree, the healthier the liver. A CAP score of 5% or lower with an S1 steatosis degree indicates a healthy liver.

Is FibroScan the Same as Ultrasound?

By using the FibroScan testing method, one effectively undergoes a type of liver ultrasound. However, the FibroScan method measures tissues with much greater magnification using advanced technology. There are similarities between FibroScan and ultrasound, but they are not the same procedure.

How Should I Prepare for the FibroScan Test?

Preparation for FibroScan requires fasting for at least 3-4 hours. Comfortable clothing should be chosen to allow visualization while lying on the back with the right arm placed behind the neck. It is important to be rested before the procedure. To ensure adequate rest, the patient should arrive at the testing area 15-20 minutes in advance.

Is FibroScan Painful?

No, FibroScan is not a painful procedure; anesthesia is not required. The probe, applied with water-based gel, sends electronic waves to the right side of the abdominal cavity, allowing visualization. The patient feels these waves as a light vibration.

How Long Does the FibroScan Procedure Take?

The measurement process of the FibroScan test takes approximately 1-5 minutes. With the pre-procedure rest of 15-20 minutes, the total examination time is about 25-30 minutes. After the procedure, the patient can quickly return to their daily activities.

What Are the Limitations of FibroScan?

While FibroScan is a fast, inexpensive, repeatable, and painless method, it has some limitations. The presence of fluid in the abdomen (ascites) can alter the propagation of elastic waves, so it is not recommended for ascitic patients. It is also not recommended for use in pregnant individuals or those with implanted medical devices (such as pacemakers). The patient's physical characteristics may also be a limiting factor for FibroScan. For instance, those with a narrow intercostal space (the distance between ribs) should use an S-sized probe, while XL-sized probes are used for individuals with a body mass index greater than 28 kg/m². Although probe sizes are chosen based on the individual's weight, the presence of obesity can be a limiting factor.