Shear Wave Elastography - Reliable? Fibroscan?

[I fightis thetitis]

Hi Folks,

Yesterday, Nov 10 I received my Shear Wave Elastopgraphy report and the Mean and Median score came back 7.5 which is consistent with stage 2 hepatic fibrosis.
My fibroscan blood lab scores pre tx 90 and now 80 which is consistent with stage 4 severe fibrosis.

Super confused and I suspect the Elastography might be inaccurate. Is there another elastography that is better than Shear Wave?

I think I'm going to re check since my bilirubin and platlets are both out of range and the decline and spike were some what sudden. started at 6 mos post tx until now 18 mos  post.

Any suggestions?

Best always,

Greg

[gnatcatcher]

Greg, here's a study that compares Shear Wave Elastography with Fibroscan's Transient Elastography as well as Acoustic Radiation Force Impulse Imaging and found no significant difference in diagnostic accuracy:
https://www.sciencedirect.com/science/article/pii/S0301562915003130

When you wrote "fibroscan blood lab scores," did you mean fibrosure? Pre-tx, I had a fibrosure blood test only 37 hours after I had a fibroscan. The fibrosure came back F2 and the Fibroscan was F4. The hep doc and CNP were both surprised because, when there's a difference, it's usually the other way around.

It you decide to get a Fibroscan, fast for at least four hours beforehand. Also, if your ribs are close together, you'll need to curve your body (and do without the pillow) so that there is as much space as possible between your ribs on the liver side so that the operator pings liver and not rib.

Sorry you're still dealing with a worrisome puzzle.

Gnatty

[Mugwump]

Your bilirubin is not at all highly elevated. And your platelets are only slightly below normal. If you have recently had the flu or other infection it could have caused this. The use of certain meds, especially some antibiotics can also cause a slight drop in platelets.

I still have platelets that are only at 156,000 per microliter, only just in the normal range. I still do have a slightly enlarged spleen caused by cirrhosis so this is most likely where the extra sticky little jerks are hiding in my case .

Being cirrhotic certainly is no picnic and it is normal for us to have slightly out of range readings, in particular these ones. But you should have nothing to worry about and your readings within a few days might very well be within the normal range for both bilirubin and platelet count. 

All the best
Eric

[I fightis thetitis]

Hi Gnatty,
Yes a type-o.. Several Fibrosure's all F4. Down 10 points over 18 mos but still severe.
One Fibroscan F2.

Eric,

Thanks for the info.. Seems like there are many poster on the forums that are actually more aware of latest trends and hep c/liver disease labs interpretations then some of the practicing experts.

Makes sense as not everyone GI is expected to have the same curiosity as the patients.  Although we can hope..
I wonder if that is bc the GI's are seeing a more narrow geographical view. Whereas the forums cast a wide net of smart folks such as yourself and many others. 

These forums are a blessing and so informative bc of real life patient sharing.

Best always,

G

[Gaj]

SWE and fibroscan do appear to have similar levels of accuracy and they both usually define fibrosis levels very well at low F0-1 and higher F3-4 levels but they are less definitive in the middle range. Both have similar constraints around their accuracy such as operator experience/skill, size of gaps between your ribs, hydration levels and whether you have recently eaten. Fibrosure blood tests give a good idea of how well your liver is working pre and post treatment but will usually drop very quickly in the first few weeks of tx so less valid for describing fibrosis while on the medication. All these are much less invasive than the old standard of biopsy and even that can give some variablility in results depending on where the sample is taken due to fibrosis levels varying somewhat across the liver.

As Mugwump says, bili and platelets do move up and down in response to other things happening in our bodies. From what you say, yours changed 6 months post tx and have stayed around those new levels for 12 mths? If this worries you, for your own peace of mind it may be worth checking with your GI and asking him to think outside the square of cured HCV patient. Sometimes even the experts can fall into the expectations trap.

Best wishes

[I fightis thetitis]

Thanks Gaj,

I hope you are doing well.
Yes bili/plats changed around 6 mos post tx and have stayed around the same for 12 mos.
I'm not reading too much into my fibroscan.
While F2 is encouraging, I do take into account the nurse doing the scan was fairly new.
I did my research and understand you can get false pos or negs based on several factors. Accuracy is a little suspect but what the heck..I'm feeling positive!

Best always,

Greg