Liver Fibroscan in Turkey: non-invasive assessment of fibrosis and fatty liver

What is Fibroscan?

Fibroscan is a cutting-edge medical technology used to assess liver health without the need for a biopsy. This test is based on a method called liver elastometry, a type of ultrasound that measures the stiffness of liver tissue.
The stiffer the liver, the more it may indicate the presence of fibrosis, fatty liver (steatosis),or NASH (non-alcoholic steatohepatitis).

This painless test takes only a few minutes and is performed using a probe placed on the skin over the liver. The device sends gentle vibrations through the liver tissue, and the speed at which they return allows doctors to evaluate liver elasticity with reliability comparable to a biopsy in many cases, without any invasive procedure.

In Turkey, especially in specialized clinics in Istanbul, Fibroscan has become a standard examination for the early diagnosis and monitoring of liver diseases. It can be repeated regularly to track the progression of hepatitis, fibrosis, or fatty liver. While generally safe and non-invasive, like any medical procedure, it has limitations and may not be suitable for all patients (e.g., those with ascites, severe obesity, or pacemakers).

Why would you do a fibroscan?

The Fibroscan machine was initially used in patients with chronic hepatitis C. Nowadays, specialists have been using it for the diagnosis of several chronic liver diseases, including:

• Alcoholic liver disease
• HIV-HCV coinfection
• Cirrhosis of the liver
• Chronic hepatitis, such as hepatitis B or hepatitis C.
• Nonalcoholic steatohepatitis (NASH).

The Fibroscan test in Turkey can also track other chronic metabolic pathologies, such as obesity and type 2 diabetes, which can sometimes be accompanied by fatty liver disease.

Moreover, Fibroscan quickly assesses liver health. It is useful in many clinical contexts such as the diagnosis of liver disorders, the monitoring of diseases, the prevention of certain liver complications, and the estimation of disease prognosis.

Fibroscan measures liver stiffness and fat content, providing complementary information to blood tests that determine liver function, such as prothrombin and platelet levels, liver enzymes, and so on.

How does the procedure work?

Fibroscan is a quick, non-invasive, and completely painless procedure, very similar to a standard ultrasound. It uses a technology called controlled vibration transient elastography, which measures liver stiffness based on the speed of a shear wave traveling through the liver.

During the exam, the patient lies on their back with the right arm positioned behind the head to expose the area to be examined. The doctor then places an ultrasound probe between the ribs, over the liver. This probe emits a low-frequency mechanical wave (around 50 Hz) that passes through the liver tissue.

The faster the wave travels, the stiffer the liver, which can be a sign of advanced liver fibrosis. The device records the echoes of the wave and calculates liver elasticity in real time, expressed in kilopascals (kPa).

The procedure usually takes about 5 to 15 minutes. No anesthesia or special preparation is required, except for fasting for 2 to 3 hours beforehand.

What is the result?

In Turkey, Fibroscan results are available immediately after the examination, allowing the doctor to start the interpretation straight away.

Liver stiffness is measured in kilopascals (kPa). The value reported is the median of about 10 valid measurements, and it ranges between 2.5 and 75 kPa.

Fibrosis is staged from F0 to F4 (METAVIR scale). Thresholds depend on the cause of the liver disease and on the device. For example, in chronic hepatitis C (Castéra et al., Gastroenterology 2005),the thresholds were:

• Below 7.1 kPa: no or minimal fibrosis (F0-F1).
• 7.1 to 9.5 kPa: significant fibrosis (F2).
• 9.5 to 12.5 kPa: severe fibrosis (F3).
• 12.5 kPa and above: cirrhosis (F4).

In fatty liver disease, alcohol-related disease or hepatitis B, thresholds differ. Liver inflammation, a recent meal, obesity and ascites can also affect the value.

Fibroscan results must always be interpreted by a specialist physician. They must be compared with your clinical, biological, and possibly radiological findings, and your doctor may order further tests, including a biopsy, to confirm the diagnosis.