Liver ultrasound

[Sam1224]

What is normal? I have a fibrosure F4 score. Cirrhosis
Findings for ultrasound:
heterogeneous echogenicity, coarse echo structure, smooth contour, portal venous flow direction: normal.
Anybody have a comparison? Or learned comment?

[koifish54]

All I know that fibrosure blood test is not a very accurate test my fdr said I never use that blood test

[Lynn K]

Unfortunately ultra sounds can't really diagnosis cirrhosis they are usually used to check portal vein flow and look for HCC tumors. The "Gold Standard" for cirrhosis diagnosis is the liver biopsy. For folks with less liver damage both fibrosure and fibroscan have limitations and are less accurate. They are best when all signs indicate cirrhosis to confirm that finding.

How are your platelet counts? They tend to fall significantly in cirrhosis. Mine for example are about 90 when 150 is minimum normal. For me that is because I have somewhat increased portal vein pressure although my portal flow is also called normal like your result. This is causing my spleen to enlarge and sequester platelets.

Portal venous flow normal is good it means you don't have bad enough portal hypertension to reverse the normal direction of flow.

other info I found on the web



Coarsened hepatic echotexture is a sonographic descriptor where there uniform smooth hepatic echotexture of the liver is lost. This can occur due to number of reasons which include:

    conditions that cause hepatic fibrosis
        cirrhosis
       
Echogenicity (misspelled sometimes as echogenecity) is the ability to bounce an echo, e.g. return the signal in ultrasound examinations. In other words, Echogenicity is higher when the surface bouncing the sound echo reflects increased sound waves. Tissues that have higher echogenicity are called "hyperechogenic" and are usually represented with lighter colors on images in medical ultrasonography. In contrast, tissues with lower echogenicity are called "hypoechogenic" and are usually represented with darker colors. Areas that lack echogenicity are called "anechogenic" and are usually displayed as completely dark.

I am thinking smooth contour is a good thing as a healthy liver is smooth and a cirrhotic liver has a rough appearance and also because I could not find much for that

a link to some scholarly articles about ultrasounds

http://www.jultrasoundmed.org/content/21/9/1023.full.pdf

EFSUMB – European Course Book
Editor: Christoph F. Dietrich

Ultrasound of the liver
Christoph F. Dietrich, Carla Serra , Maciej Jedrzejczyk

http://202.120.224.199/picture/article/186/12/38/f59739554eef9f2138151116a918/58b78c8f-785f-4584-9c55-6ce131f6f21b.pdf

Hope that helps some

[Sam1224]

Lynn
Thanks much. I appreciate your time and effort. I just had that ultrasound. I am waiting to find out if I qualify for additional 12 weeks of Harvoni. Otherwise I take my last pill Friday. By the way my platelets are at 137 up from 107.

[Lynn K]

Hi Sam

Have you been diagnosed with cirrhosis and are treatment experienced? I believe that is the determining factor in if you should be treated for 12 weeks of 24.

Great news about the platelets maybe your liver is healing already!

But anyway hope your treatment is going well and you are able to beat hep c forever!

[Sam1224]

I am treatment naive. I know protocol says 12 weeks. I was initially okayed for an additional 12 weeks but now questions have arisen. I'm not sure if I would want to do 12 more weeks even if I could.

[Lynn K]

Well having the 12 weeks with the 12 week additional option is great always good to have options.

Have you been having a hard time with treatment is that why you said you don't know if you would want to extend tx?

Can I ask what kinds of questions have arisen? Is your viral load still weakly detected? Or have you gotten an virus not detected result?

Anyway best of luck hope you slay the hep c dragon

[Sam1224]

Well having the 12 weeks with the 12 week additional option is great always good to have options.

Have you been having a hard time with treatment is that why you said you don't know if you would want to extend tx?

Can I ask what kinds of questions have arisen? Is your viral load still weakly detected? Or have you gotten an virus not detected result?

Anyway best of luck hope you slay the hep c dragon

Not having a particularly hard time with treatment but concerned about the possibility of undocumented long term effects. Also, I am just looking forward to putting all of this behind me.

The questions that arose were related to justification for 12 additional weeks.

GT 1b
treatment naïve
fibrosure F4
4 week  VL <15 detected
11 week VL UD

ION 1 results show 94% 12 weeks for my profile with no available results for 24 weeks.
ION 2 results show 100% for treatment experienced with cirrhosis with 24 weeks. Albeit a small sample size.

On the face of it, it seems like 24 weeks is the way to go. I've already received my 4th bottle of pills.
One would think that once 12 weeks has been purchased at retail price, given the low cost to manufacture the pills, a free additional 12 weeks to improve the odds would be reasonable. Unless there really is no benefit. Thoughts?

[Lynn K]

Well the recommendation per the prescription for you being treatment naive is 12 weeks the 24 is for prior treatment failures with cirrhosis so if you can get 2 weeks kinda up to you.

Personally I worry 1000% about long term effects of cirrhosis and 0% about the effects of the meds without tx I likely don't have much time left so not treating is not an option so I don't worry about the effects of the meds vs dying of liver disease

[BubbaT]

Hey Sam, Lynn

I was wondering Sam, how old are you?  Maybe that would be a help in determining if you should go another 12 weeks or not.

Are you having extra hepatic manifestions, like pct or elevated iron?
Is all your blood profiles normal?

Thanks, curious why you need 12 more weeks.




@lynn   Are you having pct and elevated iron?
Are your platelets normal now?
I was reading another thread about iron and pct and have become interested to know
What these extra hepatic manifestions mean relative to cirrhosis ?
And I was wondering if you are experiencing more issues than me since we are both cirrhosis .
Thank Yous!

[Lynn K]

Nope no PCT. No blood testing for iron levels.

Pitting edema, a small amount of Ascites, an enlarged spleen which are all caused by portal hypertension. So the reason for my low platelets is my enlarged spleen is sequestering the platelets which is a common symptom of cirrhosis. I also developed grade 3 esophageal varicies which required banding about 3 years after my initial diagnosis with cirrhosis. So in addition to having abdominal ultrasounds, AFP and liver functions, CBC, CBP, and EGF I also have an annual upper endoscopy to check for reoccurrence of  the varicies. No Hepatic Encephalopathy that I know of normal creatinine and albumin. INR 1.1 Child "A" MELD 7. 

Currently platelets have been greatly improved I saw 124 once but I understand that is a side effect of Ribavirin. I am anemic from the riba minimum normal for HGB for a female is 11.1 and mine is holding steady at the lowest level the doctor likes to see 10.0 while taking 1000 mg riba.

I was diagnosed with cirrhosis in January 2008 by biopsy and rechecked by fibroscan last fall just in case my insurance wanted something more recent I think the number was like 75.

[Sam1224]

"I was wondering Sam, how old are you?  Maybe that would be a help in determining if you should go another 12 weeks or not.
Are you having extra hepatic manifestions, like pct or elevated iron?
Is all your blood profiles normal?
Thanks, curious why you need 12 more weeks."

I am 61 yo. male  F4 fibrosure recent ultrasound showed smooth contour, coarse echo structure, heterogeneous  echogenicity.
<15 detected week 4
UD week 11       antibody 31.5 normal? good? No idea
protein, total 8.6
platelets 137
ast 24
alt19
All other results on test panel are within normal range.
Not sure about iron or PCT. I don't see that referenced.
Using my handy dandy clinical calculator:
APRI score=.922
FIB-4 score=2.45
These are using my most recent test results. Prior to treatment it would have not looked good.

I wanted the additional weeks just to better the odds of success.
From what I see the odds go from 94% to 99%-100%.

If I thought I could forego the extra weeks so that someone who would otherwise be denied could receive treatment, I would. But that's not how it works.
Thoughts?

[Lynn K]

As far as the antibody test that shows you have been exposed to hep c even if you clear the virus you will always test positive for the antibodies for hep c they are produced by your body when it attempted unsuccessfully to fight of hep c you will have them forever. Much like if you either had the measles or had the measles vaccine you have antibodies circulating to measles. In the case of measels antibodies they can prevent later actual measels infection. Unfortunally hep c antibodies afford no such protection so even I you clear hep c you can still be re-infected again.

[BubbaT]

"I was wondering Sam, how old are you?  Maybe that would be a help in determining if you should go another 12 weeks or not.
Are you having extra hepatic manifestions, like pct or elevated iron?
Is all your blood profiles normal?
Thanks, curious why you need 12 more weeks."

I am 61 yo. male  F4 fibrosure recent ultrasound showed smooth contour, coarse echo structure, heterogeneous  echogenicity.
<15 detected week 4
UD week 11       antibody 31.5 normal? good? No idea
protein, total 8.6
platelets 137
ast 24
alt19
All other results on test panel are within normal range.
Not sure about iron or PCT. I don't see that referenced.
Using my handy dandy clinical calculator:
APRI score=.922
FIB-4 score=2.45
These are using my most recent test results. Prior to treatment it would have not looked good.

I wanted the additional weeks just to better the odds of success.
From what I see the odds go from 94% to 99%-100%.

If I thought I could forego the extra weeks so that someone who would otherwise be denied could receive treatment, I would. But that's not how it works.
Thoughts?

Hi Sam, are you feeling well after 12 weeks treatment?

Do you have better energy and less pain in the liver?

[Lynn K]

Also as you are GT 1b your cohort has better results than gt1a.

As you are treatment naive and GT 1b the recommendation is 12 weeks even with cirrhosis but that is up to you and your doctor .

[Sam1224]

I do feel better with more energy but sometimes it feels like the medication is wearing on me. That was why I was considering forgoing the extra 12 weeks even if I could get it. But after reviewing the ION studies it seemed worth doing the extra 12. I suspect that it's been known all along that 24 weeks will yield a higher cure rate  but the 8 and 12 weeks are still "breakthrough drug" worthy numbers.
I've never really felt pain in the liver. Maybe I didn't notice it.

[Debula]

Hi Lynn
My story sounds very similar to yours from what I can understand anyway
You mention in your post " I also developed grade 3 esophageal varicies which required banding about 3 years after my initial diagnosis with cirrhosis"
My doc wants me to do an upper endoscopy and I am kind of scared.  Also how exactly do they do the "banding" if it is needed?  Do they do it at the same time?
Or is it a different procedure?
Thanks
Deb

[Lynn K]

My first upper endo immediatly after I was dx with cirrhosis I had grade 1 varicies. Two years later they were grade 2 and the next year they were grade 3. I did those at  my doctors office. For the bandings which started the following month were done at the hospital. They just do upper endoscopies and apply bands they can only do so many at a time so I had to repeat monthly for 4 sessions.

Many people as also treated wth beta blockers instead of banding. This reduces portal vein pressure with the goal to reduce resting heart rate to about 60 however my resting heart rate is already 60 so we did the bandings instead. Some prefer the banding as it actually physically destroyes the enlarged veins reducing the bleeding risk.

Hope that helps

[Debula]

Thank you Lynn this does help a lot
Do they put you to sleep when they do these procedures?  I guess if he did it in his office they must not.. I'm a big baby I think

[Lynn K]

In office is in the endoscopy center at my old gastroenterologists office. Technique is called conscious sedation. I have no memories of the procedures.  They either used Propofol or I think it was Verapamil or maybe Versed or both of those together.