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Post Info TOPIC: I was not expecting this.
Tig


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Hi JC,

Welcome to the group! I can't offer much more than Canuck has. When you have such polar opposites from differing tests, your doctor needs to dig deeper. I would ask to have the tests repeated, at the very least. He/She should be the first to recognize that something is amiss and redo the exams. Occasionally a high BMI will alter results, but not a completely opposite swing in them. Without seeing all of your tests, blood work, and ultrasound results, it's a guess for us as well. We aren't doctors, just knowledgeable observers and opinionators. There are additional fibrosis testing procedures that can be done if needed, such as biopsy and MRI. Steatosis is well known for causing altered fibrosis readings on Fibroscan. There are improvements to that procedure to make a better determination, but the lab doing the test has to have the equipment to do it.

My advice is to contact your healthcare provider with your questions and see what their impression is. Obviously one of them is wrong and a complete evaluation of those results  should be accomplished. The thing to remember is that with these new treatments, fibrosis levels have little impact on rates of success. Obviously you want to treat as soon as you can, it's a wise choice for all people infected with HCV. Good, bad or otherwise, treatment is the key to stopping any further progression. Only then can you start the healing process.



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Tig

62 yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 1-4 years!

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Hi John,

Welcome here.

I'll take stab at your question about ARFI, but Tig will soon be along, and he likely is much more familiar with that particular method used for determining fibrosis levels. I am not "up" on ARFI.

I would agree with your thinking thus far, that "certain" factors may be skewing the results of one fibrosis test (ARFI) when compared to another fibrosis test (Fibroscan). 

Below is just an abstract discussing ARFI, if this helps. In it, it discusses influences of BMI/ perhaps body fat depths that can influence measurement:

_____________________________________________________________________________________________________

 

J Ultrasound Med. 2016 Nov;35(11):2373-2380. Epub 2016 Sep 23.

Liver and Spleen Stiffness Measurements by Point Shear Wave Elastography via Acoustic Radiation Force Impulse: Intraobserver and Interobserver Variability and Predictors of Variability in a US Population.

Balakrishnan M1Souza F2Muńoz C2Augustin S2Loo N1,2Deng Y3Ciarleglio M3Garcia-Tsao G4,5.

Author information

 

Abstract

OBJECTIVES:

Measurements of liver stiffness and spleen stiffness are useful noninvasive ways to assess fibrosis and portal hypertension in patients with chronic liver disease. One method for assessing stiffness is by point shear wave elastography via acoustic radiation force impulse imaging (ARFI). Its advantage is that sites where stiffness is measured are visualized sonographically. However, its reliability has not been well established, and all studies done to date evaluating the use of ARFI in chronic liver disease have been performed outside the United States. We aimed to characterize the intraobserver and interobserver variability of ARFI-measured liver and spleen stiffness.

METHODS:

Two hepatologists evaluated unselected hepatology outpatients with ARFI. Exclusions were hepatocellular carcinoma, ascites, a surgical shunt or transjugular intrahepatic portosystemic shunt, portal thrombosis, and cholestatic disease. Each operator obtained 20 measurements from the right liver lobe and spleen. Intraclass correlation coefficients (ICC) were calculated.

RESULTS:

A total of 177 patients were included: median age, 61 years; 85% male; and 43% obese. Intraobserver ICCs were the same for both observers for liver stiffness (0.89; 95% confidence interval [CI], 0.85-0.92) and spleen stiffness (0.72; 95% CI, 0.61-0.80). Interobserver agreement was excellent for liver stiffness (ICC, 0.85; 95% CI, 0.76-0.90) but not as good for spleen stiffness (ICC, 0.73; 95% CI, 0.60-0.83). A body mass index of 30 kg/m2 or greater, waist circumference of greater than 105 cm, and skin-to-capsule distance of 2 cm or greater negatively affected the ICC for liver stiffness; small spleen size negatively affected the ICC for spleen stiffness.

CONCLUSIONS:

To our knowledge, this article is the first report of ARFI findings in a US population with chronic liver disease. Liver stiffness reproducibility was excellent, particularly in nonobese patients. Spleen stiffness reproducibility was excellent in those with larger spleens and therefore may be most useful in patients with cirrhosis and portal hypertension.

KEYWORDS:

acoustic radiation force impulse; gastrointestinal ultrasound; liver stiffness; point shear wave elastography; spleen stiffness; ultrasound-based elastography

PMID:
27663656
DOI:
10.7863/ultra.15.10056
[Indexed for MEDLINE]
___________________________________________________________________________________________________________________________

Neither is a "Fibroscan" infallible in 100% accuracy.

Values can be skewed, especially if you have had "only one", of a certain test, and not many repeats to compare to. Repetitions of the same and/or similar tests (and better yet multiple methods of fibrosis tests all repeated overtime) can best help confirm the tendancies/accuracies.

When you have had one test only (ARFI) and it is low, and one test only (Fibroscan) and they are polar opposites, this conflict can lend nothing to support each other as a trend.

Having said that, if the ARFI and the Fibroscan are the only 2 tests you have had done to this point, that you can base your fibrosis levels on, for now, then I would side with the Fibroscan value, as it is less likely to have an erroneously high value Fibroscan, than it would be to have a false negative (low) ARFI. But I am guessing.

Fibroscan uses a LSM (liver stiffness measurement) expressed in kilopascals (kPa's), which converts to a F0-4 score range. http://hepcbc.ca/tests/non-invasive-tests/fibroscan/

ARFI uses a different measurement and is expressed differently SWM (shear wave measurement) and m/s, which converts to an F0-4 score scale as below (I believe):

ARFI reference values:

  • 1.35 - absent or mild fibrosis (F0 or F1)
  • 1.35-1.55 - significant fibrosis (F2)
  • 1.55- 1.80 - severe fibrosis (F3)
  • >1.80 - cirrhosis (F4)

Your Fibroscan result (I am guessing) is written as 21.6 kPa on your results?, and 21.6 kPa's does convert to F4 - but, do you happen to know any other "number" or measurement for your ARFI result ? - (other than that your ARFI is F0)?

Your doc (or docs) in their assessements of you may, have also done some other fibrosis and inflammation testings on you, by bloodwork - if you wish to share the blood tests you may have had done already or the results you know of, we may be able to see some other indicators of fibrosis. 

This is an old thread, why don't you post a brand new thread (in the "New Members" area), so you can have a place that will be just for you, and let us know more, what is going on, how you are, and where you are at. We will be happy to assist in any ways we can.

Your genotype (GT), viral load (VL), how long you might have had HCV, and tests results (such as ALT/AST/GGT/AFP/Billirubin) would be informative/helpful info to share for discussion or for questions you might have, in case we can help with info or be of help in any way.

Fire away if you have questions. smile C.



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HCV/HBV 1973. HBV resolved. HCV undiagnosed to 2015. 63 y.o. F. Canada.

GT3a, Fibroscan F3/12 kPa - F4/12.6 kPa, VL log 7.01 (10,182,417), steatosis, high iron load.

SOF/VEL with/without GS-9857 trial - NCT02639338.

SOT March 10 - EOT May 5, 2016 - SOF/VEL/VOX 8 week trial.

 

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Hello all, Iām new here and this is my first post. For some reason I canāt read the original post. If I got it right from the replies, it was a high Fibroscan score thatās now F0? Were both scores on Fibroscan? The reason Iā asking this is because Iām having a 21,6 F4 score on Fibroscan and F0 on ARFI, but Iām still not on treatment yet, but I was wondering if this could be related to belly fat.

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Tig


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Jimmy,

Steatosis (fatty liver) is known to impact the ability of the Fibroscan sound wave through the liver. Considering her HCV is now in the rearview mirror, the steatosis is more than likely improving and allowing a better signal pathway. It's a good thing!



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Tig

62 yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 1-4 years!

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movebo wrote:

Hi Jimmy,

great stuff, absolutely. That is the kind of thing we all hope to hear.

Congrats to both of you!

Cheers, Tom


 Hi Tom,

Thanks that is EXACTLY why I posted the results. I want folks out there to grab on to the fact that the "Cure" is real and we live in an incredible time where it is also quite easy.

I want people to gain hope from the posted results. wink

JimmyK



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Harvoni TX 2 12 weeks. UND weeks 4, 12 and now EOT + 4 Weeks. SVR-12 09/29/16. All Glory, Honor and Thanks be to God.

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Tig and C-Chick hello.

"Like Canuck, I notice the diagnosis of steatosis and with the HCV resolution, it wouldn't surprise me a bit if that was a key factor in the reduction of the original fibrosis score."

 

Forgive my ignorance but I do not understand the above comment.

 

JimmyK



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Harvoni TX 2 12 weeks. UND weeks 4, 12 and now EOT + 4 Weeks. SVR-12 09/29/16. All Glory, Honor and Thanks be to God.

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Hi Jimmy,

great stuff, absolutely. That is the kind of thing we all hope to hear.

Congrats to both of you!

Cheers, Tom

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M, 59,

7/14: VL 4E6, F0-2 MRI TE

8/15: biopsy, A2F4

SOT 8/15 - Harv./RIBA 12 wks

12 wks post: UND, ALT 21, AST 21, GGT 23, platelets 206

75 wks post: UND, ALT = AST = GGT = 20, platelets 224, AFP  3 

Tig


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Incredible results, Jimmy! I spoke to the boss about this and she was equally surprised and happy for you both. There should be nothing but joy and thanks for such an amazing turn around. The latest biopsy techniques take a multi sample approach, so I'm sure that would confirm or deny these results. You might also ask whether MRI or CT would be warranted before an invasive procedure.

Like Canuck, I notice the diagnosis of steatosis and with the HCV resolution, it wouldn't surprise me a bit if that was a key factor in the reduction of the original fibrosis score. 

This just makes us all smile, simple as that! My congratulations goes out to you both.

Believe in

 



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Tig

62 yo GT1A - 5 Mil - A2/F3 - (1996) Intron A - Non Responder, (2013) Peg/Riba/Vic SOT:05/23/13 EOT:12/04/13 SVR 1-4 years!

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woo hoo a bit fat ZERO! 

Love it. Very happy for you and Carolyn. 



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1999 TX 1 - Inter -non responder 2001 TX 2 - Peg + Riba - viral load tripled and taken off

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Oh my, do I EVER like these oddities! - I don't care (exactly) HOW we arrive at F0! As long as it SAYS F0 (curiously, or not)!! biggrin

Those results sound good to me!

I too could not believe my last good fibroscan results, too "suddenly good" to be true I thought, so, I soon decided to accept the result (willingly) at face value just on principal and reserve final judgement until I have a couple more repeat confirmations under my belt to back up this good news.

I see you two get those (unfamiliar to me) "combined" on the same machine U/S TE's.

My "imagings" (via ultrasounds or CAT) are simply "the pictures", done separately, and are "the added info" to my Fscore kPa "stiffness" level I am at via the fibroscan. 

I recall Mallani and a few of the others have spoken about these "at the same time" MRI TE and/or U/S TE machine methods?

I see no reason why (necessarily) one should be subjected to a liver biopsy, just to solve a minor curiousity as to why there may remain some lagging signs of nodularity "shape", mostly to disprove a marked reduction in a liver stiffness estimation)?, and especially when the short term consequences of doing so (having a biopsy), may only end or lessen a better, gooder, longer, fuller surveilling program. One can always have a biopsy, at a future point, if a mystery persists to solve - no? Why does he not make use of some added imagings such as CATs, first, over biopsying at this cross-roads, CATs may afford a "bit" more info too, in the "interim". Has she ever had a CAT? Why the hurry to biopsy only and then do less surveilling right now?

You know me well JK, in my perfect world, I prefer liberal health dollar spending, and in receiving the MAX. testing and imagings. Just based on "monitoring" ALL of my liver health and recovery (NOT just looking for Ca) - just my hx of HCV, being a prior F4, having a fatty liver, and any prior noted abnomality, I would want ongoing MAX. surveillance for quite some time - what is the dif and cost between good MAX. ongoing monitoring (of recovering livers like ours) and Ca surveillance anyway, not much I figure.

Should one be a willing participant and strong believer in the goodness of a liver biopsy, then I would welcome it too, but only if my ongoing surveilling was not "curtailed" or compromised/lessened to be inferior to what I had been allowed to have before. If I had continuing nodularity then I would want at least the same surveilling I was getting and maybe CATs as well, and then a biopsy IF the if the pictures over time do not clear up the mystery, not biopsy in order to to create less testing and following.

(I may be speaking quite out of turn here, not knowing much about this stuff) but personally I would be, for now, leaning toward repeating what you currently get for a while, and see if the same good curious results keep returning.

My first ever (pre-treatment) U/S showed diffuse steatosis, and the separate pre-treatment fibroscan results quickly crept from F3 to F4 (12.6 kPa's) - if I accept that those intial results were truly accurate). I have read that (perhaps?) fatty livers themselves may be contributing to skew the kPa "stiffness" of fibroscans upward. Perhaps my "hardness" was not strictly "fibrosis" but in part, a fatty liver contributing to it's stiffness as well? On my first post-treatment U/S, there was no mention of steatosis, and post-treatment I had a complete drop to a normal Fscore by fibroscan! That was my good news "curiosity".

They note a current "steatosis" on her report, if current, then that too just confounds supporting why she went to F0 so well (if the fat theory holds any merit). But I am at a loss to know all of the possible testings she has had done and all the dif. methods she may have had them done by. Whether her first Fscore was arrived at by biopsy, whether she has had many of the exact same U/S TE's all along to compare one against another, the attached report speaks of comparing this US/TE to her last US (no TE mentioned) - and no mention of her Fscore with that prior US either, so, does that mean her last US was without TE? Many repeats, with consistancy (same tests, same equip, same method, and preferably with the same operator read by the same radiologist0 must make help make it all the more telling - no?

Biopsy, held by some as the gold standard, can be a telling hit or miss pin prick point in time, it too has it's falliblities, just like other methods are not infallible. If one is partial to biopsying, then why can't you have both worlds, biopsy AND continue on with the MAX. non-invasive liver health surveilling to best deduce things, not less testing?

What is YOUR thinking on the whole of your ladies test results JK? You got it figured?

And hey, when the heck are you going to get around to having your "cut-down" blood letting session - weren't you due?

I am of the mind that you should just frame that beauty F0 test result, (it will go good, lined up together, side by side, right next to your own framed results) -  a matching pair!, and just keep right on truckin' being frequent flyers for tests, and savour any wished for biopsying for just about anytime, later?. biggrin C. 



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HCV/HBV 1973. HBV resolved. HCV undiagnosed to 2015. 63 y.o. F. Canada.

GT3a, Fibroscan F3/12 kPa - F4/12.6 kPa, VL log 7.01 (10,182,417), steatosis, high iron load.

SOF/VEL with/without GS-9857 trial - NCT02639338.

SOT March 10 - EOT May 5, 2016 - SOF/VEL/VOX 8 week trial.

 

(SEE UPDATES IN BIO)



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FAN-tastic !!!!



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60y/o, Infected via transfusion Oct'83, GT-1a, F-4 cirrhotic,
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2.5years...post tx... successful dragon slayer 



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Greetings,

Carol had her six month follow up to monitor for liver Cancer. This due to the fact that she was considered an F-4 prior to SOT.

The Liver Stiffness test came back F<0.

They are saying the contour "suggests" cirrhosis, but that is it. This is insanely good news!

I am a bit ....



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