II. Indications
- Second-Line study for evaluation of MASLD or other Chronic Liver Disease related Liver Fibrosis
- May avert need for invasive testing (e.g. liver biopsy)
- Confirmation or first-line study with intermediate to high probability of fibrosis
- Fibrosis Probability Score
- NAFLD Fibrosis Score
III. Efficacy: False Positive causes
- Recent meal
- May transiently increase liver stiffness
- Patient should fast 3 hours before study
- Acute liver inflammation
- Liver transaminases >5x normal
- Recent Alcohol use
- Right-sided Heart Failure
- Severe Obesity (BMI >40 kg/m2)
IV. Imaging: Magnetic Resonance Elastography (MR Elastography, MRE)
- Most accurate for measuring Liver Fibrosis
- Preferred if BMI >36.65 kg/m2
- MR Elastography (MRE) score > 3.62 kPa is suggestive of advanced fibrosis
- MRE < 2.5 kPa: Normal (F0)
- MRE 2.5 to 3.5 kPa: Mild to moderate fibrosis (F1 to F2)
- MRE 3.5 to 4.0 kPa: Moderate to bridging fibrosis (F2 to F3)
- MRE 4.0 - 5.0 kPa: Advanced bridging fibrosis (F3 to F4)
- MRE = 5.0 kPa: Cirrhosis (F4)
- Tertiary Center Imaging Biomarkers (e.g. proton density fat fraction, iron corrected T1 mapping)
- Consider when other results are inconclusive for significant Hepatic Fibrosis
V. Imaging: Vibration-Controlled Transient Elastography (Fibroscan)
- MR Elastography is preferred for accuracy (but is less available and much higher cost)
- Fibroscan cost is estimated at $35
- Imaging study with high sensitivity for even mild Liver Fibrosis
- Fibroscan > 9.9 kPa is suggestive of advanced fibrosis
- Low Risk <8 kPa
- Intermediate risk 8-12 kPa
- High risk >12 kPa
- References