What is FibroScan for liver fibrosis
Up until now it was necessary to perform a liver biopsy in order to determine the remodeling of the connective tissue in the liver (degree of fibrosis / cirrhosis) due to chronic liver disease. The liver biopsy is an invasive (penetrating into the body) procedure that is not always painless and uncomplicated. There has been an alternative since 2005: painless elastography (FibroScan®). It is used to determine the remodeling of the connective tissue in the liver (development of fibrosis and cirrhosis). This procedure has become established. Many liver specialists in practice and clinic have recently started offering their patients this procedure. In recent years, many studies have proven the benefit and the good applicability of this FibroScan® for all diseases of the liver.
The elastography can identify the connective tissue remodeling of the liver in close agreement with the otherwise invasive liver biopsy. At the same time, this procedure can be used to check the success of a drug therapy in the course of the process (regression of the fibrosis). We have also been using this technique to measure liver fibrosis since mid-November 2006. We were one of the first centers in Germany to use this method. We therefore have a high level of experience in the implementation and interpretation of the findings.
How does the investigation work?
The device from Echosens (Paris) has a special transducer that is placed in an intercostal space at liver level. The head contains a 50 Hertz vibrator that emits a low-frequency wave with a propagation speed of 1 m / s. A 5 MHz ultrasound probe is also integrated. The more solid and inelastic the liver is (fibrosis), the faster the waves run through the liver and deform the tissue. This is observed and measured at the same time with the ultrasound probe. The deformation is given as a numerical value in kilo-Pascal (kPa). The more the liver is remodeled by connective tissue, the lower the deformation and the higher the measured values. A healthy liver measures 3-4 kPa, liver cirrhosis is to be suspected at> 12 kPa. Advanced cirrhosis of the liver measures 20-70 kPa.
The examination is painless and without side effects! The emission of the sound wave corresponds to a light tap on the abdominal wall. The examination can be repeated at any time.
Another advantage of the examination: It is independent of the examiner. However, this requires experience in finding the optimal examination point. Classic ultrasound can help here! At least 10 ultrasonic waves are emitted and evaluated per examination. The finding is only meaningful if the agreement between the measured values is high! The examination takes 5-15 minutes.
The examination should be carried out after a period of 2-4 hours without food.
Are there limits to the investigation?
Yes, if you are very overweight, have low lungs and ascites, the technique can fail.
Advantage of the "non-invasive" FibroScans®?
With the liver puncture only one 50,000th of the liver tissue is examined, the elastography can detect 100 times the amount.
Will the liver biopsy be superfluous in the future?
No. FibroScan® records the extent of the connective tissue remodeling in the liver and the dynamics in the chronic course of the disease. This is the most important prognostic factor! However, FibroScan® does not record the extent of the current inflammation and does not help to identify the cause of the liver disease.
Who should have a FibroScan® examination carried out?
It is about the follow-up of chronic liver diseases. We recommend an annual check-up in order to follow the progress of the scarring in the liver (fibrosis) or its reduction after or under successful treatment. The results are of great prognostic importance.
Do health insurances pay for the examination?
The investigation procedure is new. So far there are no fee figures from the statutory health insurance for the examination technology. Most private health insurances reimburse the service. In our practice, the examination costs € 60. This includes a detailed discussion of the findings. In addition, a “classic” ultrasound is required, which is reimbursed by the health insurance companies. Therefore, patients of the statutory health insurance are asked to bring a referral slip with them in order to save the "practice fee"!
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