Hep C Discussion Forum

Hi Peri and welcome from me too.

 Since being diagnosed as F4 decompensated cirrhotic 1-2014 and F4 cirrhotic 5-2015 I've been having MRI's every 3 months to monitor a lesion on my liver for HCC and the radiologist final report always includes a comment about the liver being "cirrhotic". But a couple of the last few reports have described it as "mildly cirrhotic". MRI is not as accurate as biopsy in determining degree of fibrosis, but it is accurate enough to see improvement in fibrosis regression via series of reports over time from the same source. So long as I am having MRI's to monitor for HCC I really have no need to have a biopsy. I have achieved SVR, I treat my liver well, the lesion has drastically improved and I was reduced to MRI every 6 months now as a result of the positive progress. My lab results are now all normal too with the exception of platelets @ 74, but that continues to improve as well. A biopsy could not have made that happen any faster or better. The way I see it: Why should I worry about the exact condition of my liver or have them poke holes in it for biopsy if I know I am HCV free, doing everything possible to allow it to get healthier, it's working (according to MRI's), and that it is being monitored for HCC.

 This is just me and I understand ones desire to have an accurate assessment of their condition. I would also if I was not having MRI's done periodically.

 As mallani (Malcolm) said, "Geno 3 progresses to cirrhosis faster than other Genotypes. If you've had it for 30 years, cirrhosis is a real possibility" Fibrosis could have progressed significantly since "08". If I was geno 3 for 38 years and my ultrasound report said, "looking irregular/nodular, basically cirrhotic looking", then I would expect my doctor to investigate further with CT or MRI, and if this is confirmed then start periodic CT scans or MRI's to watch for signs of HCC. I would not be content with only ultrasounds and biopsy is not effective for detecting HCC. 

Just my 'non medical' opinion based on my own personal case.

 Congratulations to you on achieving SVR. When SVR involves geno 3 it's an especially big achievement.

Hi Peri,

Welcome to the group, I'm glad you found the forum too! We've got a lot of friendly, knowledgeable people here. I hope we are able to help you find some answers and relief from the stress associated with all of this.

I think the answer is a biopsy as well. Try your best to not be afraid of one, they really are an easy thing to accomplish. The hardest part is the paperwork and fanfare beforehand, the procedure is easy. I've had several and the last of them were done asleep. They were simple and are very reliable. It's worth considering for peace of mind.

Congratulations on your SVR! GT3 is a stubborn one, so you have accomplished a great victory already, well done! 

Hi Canuck and Mallani! 

I've had Hep C for 38 years before I was successfully treated, and I hear you Mallani, G3 seems to be an aggressive genotype. I've resisted a biopsy because I've always been scared of the very thought - I'm pretty much a coward when it comes to medical procedures. However I will implore my hepatologist to give me some certainty by way of an MRI or CT, if you think they would give a better picture of the state of my liver.

Canuck I had my first Fibroscan in '08 and it measured 5-5.6kpa; next was in '09, which was 6-4.8kpa (these older reports give a set of numbers, I'm guessing they were the predominant scores out of the 10 readings). In 2011 I scored 6.3kpa, then as stated 2014 I was 7.6 and then 1 yr post Tx 4.6. I've had a big handful of U/S over the years and they seem in equal numbers bi-polar, some see coarsened echo texture etc and others see normal texture. Looking at my medical scrapbook(!), I came across a CT scan, that I had forgotten about, which was taken in '08, which states 'liver is normal'. Btw, my ALT and AST have always been elevated above 80, since first tested and I've always had a very healthy albumin count.

So make of that what you may... Btw, you might be wondering why I never took the Interferon route - there is a family history of auto-immune disease. Post post Tx I seem to have evaded that particular nasty.

Thank you both for your replies. It does help even just to have a conversation about this. My family care but aren't up on the medical lingo, also I don't wish to worry them. So its a great relief to be here!

Cheers from Noosa :)

Hi Peri,

Welcome, glad to see you here.

I am a 3 too.

I probably shouldn't, but I'll take a stab at it. I'm no expert, that's for sure! But I am game .

Others here will follow, I am sure, and offer their best thinking.

Firstly congrats on your SVR.

Well presented info too, this will helps others to formulate responses to your query and concern.

I chose to reply right away, not that I can really answer you with any authority, but, just because i can hear your concern.

I hate to see you worrying, it sounds not too bad (to me), with your last fibroscan showing a reduction to 4.8 kPa!

My major question needing clarification would be: You DID NOT have any other prior U/S's pre-treatment?? Only the one fibrotest and one fibroscan pre-treatment? And then one fibroscan post-tretament and only the one U/S post-treatment? Is that correct?

Perhaps it would have been more telling had you had a number of "prior" U/S's, then you would have had at least other U/S's to compare to and against (pictures over time) - but, if the only assessments you had were the ones you mentioned ... then firstly, one pre-treatment fibrotest may not have been accurate. So then, just based just on the fairly substantial spread and drop of your pre and post-treatment fibroscan kPa scores alone (pre-treatment 7.8 barely into F2/possible moderate fibrosis, and post-treatment 4.8/mid-range of no/or mild fibrosis), this would likely indicate a pre to post reduction in firmness.

Until you get to talk with your doc further about this, I would go with the comment your doc made, U/S is just a tool (one tool), to be taken with salt. Your one "single" U/S does not tell you very much - like what did your liver look like before?! Your 2 pre and post fibroscans, on the other hand, as they stand, are comparative, and the kPa values and the marked decrease are not supportive of the premise of cirrhosis.

Believe me I would be very pleased to see my pre-and post fibroscan readings reduce from 7.8 to 4.8 - would be celebration time for me!

But I do understand why you would be feeling unsettled. Perhaps with more testing over time your doc will be able to re-assure you.

For what it's worth, I hope that helps some. C